Need some help on a nursing dx

[augurey]

This is my first time working with a nursing diagnosis. We're working on a hypothetical case study for our nutrition class and have to come up with 3 nursing diagnoses.

General info:

Pt is 55 year old female with mild mental retardation. She lives in an independent support living arrangement and works at a bakery in a supported employment arrangement. She is 5'5" tall and weighs 205 pounds and was recently diagnosed with diabetes. It was recommended that she reduce sugar in her diet, lose weight, and monitor blood sugar 5 times a day. She attended a 6 weeks course where she was instructed on how to monitor her blood sugar. Her blood sugar is still too high when she checks it. The doctor recommended she loses weight.

Her diet history: Favorite food is chocolate. She buys an eclair or donut on her work break. After work she walks to the convenience store and buys a coke. On the weekends she likes Chicken McNugges meal deal. She's always picked out her own food at the grocery store. She likes potato chips and ice cream which she buys every week.

Her dx is Type II diabetes, Mild MR.

Medications: Glucophage 500mg bid, Diabeta daily in the am, Lantus 10 mg subcutaneously daily in the pm.

We were given a list of nursing diagnoses to choose from. We have to choose 3 (in order of priority). Most, I would say, are self explanatory. But I'm confused on two. I've gone through the list and have written down all that I felt could be applicable to this case.

The first/priority I have picked is risk for unstable blood glucose level.

The other three I thought relevant were Imbalanced nutrition: more than body requirements, Ineffective Health Maintenance, and Ineffective Self-Health Management.

First, I'm not sure what the difference between Ineffective Health Maintenance and Ineffective Self-Health Management would be. Based on what I've found on AN for these two, they sound very similar, but I think Self-Health is more about difficulty integrating the necessary changes into their lifestyle vs inability to identify changes necessary.

At this point, I'm leaning towards Ineffective Self-Health Management and Imbalanced nutrition: more than body requirement. Then if I choose those two as my second and third, I cannot decide which one would be second and which would be third.

My thinking is that Ineffective Self-Health management would be second and Imbalanced nutrition third as the self-health management would directly effect Imbalanced nutrition.

Could anyone advise me if I'm going in the right direction on this?

Also, are there any good resources regarding nursing diagnoses and defining some of the more unclear ones (maybe they're just unclear to me?) or is this something that will just come in time by continually doing it?

[Shagce1]

Yes, I think you are on the right track. Yes, it does get easier with practice. Personally, I think having a real live patient is easier to nursing diagnose than a fictitious one because you have your own assessment data to fall back on and can ask the patient more questions or get more information from the chart to support your diagnosis. I am still pretty new to the whole care plan/nursing diagnosis thing so I am sure someone else will chime in with more specifics to help you. Do you have a nursing diagnosis book that you are working with? It can give you more information/definitions to help better differentiate some of the diagnoses.

[augurey]

Great! Thanks! :)

I am finding it difficult about it being a fictitious patient as we also have to do an assessment. The general information I originally posted is really the only information we have and our assessment requires more information. We start Fundamentals in March as well as clinicals. This is a group project, and she just wants us to go through the process once before we really start doing it in Fundamentals.

We don't have a nursing diagnosis book (yet). We just got a printout of possible nursing diagnoses to go with the different case studies that each group is working on. Many of the diagnoses look like they are self explanatory (ie risk for unstable blood glucose levels), but I feel like some of the others aren't very clear with their meaning, especially not having worked with them before. I'm assuming we'll be getting one once we start Fundamentals. At least I hope! Otherwise I'll get one, but I'm really hoping they'll give us one as part of the course.

So the book would provide more information as to what the diagnoses relate to?

[Esme12, ASN, BSN, RN]

Grrrrrrrrr.....I really do not like it when instructors do this....it only confuses students. You technically don't pick a diagnosis and then try to retro fit the patient into it. You assess your patient find out what they "need" and then look at the definitions of the nursing diagnosis's to see what applies to them the best.

Each NANDA statement (diagnosis) has very specific definitions and characteristics that the patients needs to fulfill at least one of those characteristics/definitions in order to use that diagnosis. check out this thread.....https://allnurses.com/nursing-student-assistance/case-study-care-807925.html

Ineffective Self-Health Management

Definition: Pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is unsatisfactory for meeting specific health goals

Defining Characteristics: Failure to include treatment regimens in daily living; failure to take action to reduce risk factors; ineffective choices in daily living for meeting health goals; reports desire to manage the illness; reports difficulty with prescribed regimens

Related Factors (r/t): Complexity of health care system; complexity of therapeutic regimen; decisional conflicts; deficient knowledge; economic difficulties; excessive demands made (e.g., individual, family); family conflict; family patterns of health care; inadequate number of cues to action; perceived barriers; perceived benefits; perceived seriousness; perceived susceptibility; powerlessness; regimen; social support deficit

Ineffective Health Maintenance

Definition: Inability to identify, manage, and/or seek out help to maintain health

Defining Characteristics: Demonstrated lack of adaptive behaviors to environmental changes; demonstrated lack of knowledge about basic health practices; history of lack of health-seeking behavior; inability to take responsibility for meeting basic health practices; impairment of personal support systems; lack of expressed interest in improving health behaviors

Related Factors (r/t): Cognitive impairment; complicated grieving; deficient communication skills; diminished fine motor skills; diminished gross motor skills; inability to make appropriate judgments; ineffective family coping; ineffective individual coping; insufficient resources (e.g., equipment, finances); lack of fine motor skills; lack of gross motor skills; perceptual impairment; spiritual distress; unachieved developmental tasks.

Source: Ackley: Nursing Diagnosis Handbook, 10th Edition

Now which one applies most accurately?

You prioritize by what will kill them first.....unstable glucose would be one.