one of the reasons it is difficult for me to help you is because nursing diagnoses, like medical diagnoses, are based upon the symptoms a patient has. if you have a nursing diagnosis reference and look up the nursing diagnoses you have listed you will find symptoms (nanda calls them defining characteristics) listed for each of those nursing diagnoses. your patient should have at least one or more of those symptoms (defining characteristics) in order for you to be able to use any particular diagnosis for the patient. if not, then you've diagnosed the patient incorrectly.
a diagnosis, any diagnosis, is the resulting decision or opinion after the process of examination or investigation of the facts. all kinds of professions perform the diagnosing of problems. that's just what you are doing--diagnosing problems that your patient has. the actual nursing diagnosis is nothing more than a label for the problem the patient is having. the first step in diagnosing is to perform a thorough assessment of the patient. [this is also the first step of the nursing process which is the problem solving process we nurses use.] this involves talking to the patient and going through a review of their history of symptoms as well as assessing their adls (activities of daily living). you also need to read the patient's medical record and perform your own physical assessment. from all that data that you collect you must compile a list of the abnormal data (symptoms)
and make a nursing decision (nursing diagnosis)
. you have the nanda taxonomy (hopefully, a nursing diagnosis reference book) to help you pick nursing diagnoses that match with your abnormal data (symptoms).
so, what i'm saying is this. knowing the patient's medical diagnoses just isn't very helpful in determining nursing diagnosis. it will help with understanding the underlying etiology of some of the patient's symptoms
is all. however, what are your patient's specific symptoms? that is what is needed to correctly diagnose.
there are two diagnoses that are used with skin ulcers: impaired skin integrity
and impaired tissue integrity.
the use of either is dependent on the stage of an ulcer. impaired skin integrity
is for stage 1 and 2 ulcers; impaired tissue integrity
is for the deeper stage 3 and 4 ulcers. did you stage this patient's ulcer? did someone else stage it? do you have that information? you have to know that information in order to use the correct nursing diagnosis here.
i don't like the related factors you have attached to the self-care deficits. so, the reason the patient doesn't, let's say, dress or groom himself is because his diabetes is managed poorly and because he delayed seeking treatment for the diabetes? "because i didn't get insulin for my diabetes for a year, i can't dress myself properly, and i'm incontinent." does that make sense? it doesn't to me. if you look at a reference for these self-care deficits you won't find either of those related factors listed. the related factors listed for the self-care deficits revolve around the patient's physical, mental or physiological reasons
for not being able to do their self-care. note: you have got to use a nursing diagnosis reference book as a guideline to help you out when you are first learning to use these nursing diagnoses until you are confident in your ability to use and apply them to patient problems.
what are these complex social issues that the patient has? did you use some sort of assessment tool to determine them? what specific financial problems are present? does it involve obtaining medication, medical treatment, food, or housing? these are things you need to know to determine a proper nursing diagnosis. remember to keep your eye on how finances relate to daily living needs. that's what we nurses do.
you said this patient had an amputation. i don't see anything pertaining to his mobility (ability to move around). did you assess this? is he using assistive devices? is any kind of help needed with his ability to use these devices and move around? if so, this is a nursing problem and needs to be diagnosed and care planned for.
a patient's ill management of their condition requires some further investigation as to the underlying reasons for why. this is because there are several nursing diagnoses that apply to this and you need to make the appropriate assignment. it could be non-compliance, lack of knowledge or just plain orneriness.
what is going on with this patient's depression? anxiety? coping or self-esteem problems? is he suicidal? feeling isolated? hopeless? sad? these are things that have to be assessed for. the patient's depression can be a related factor (cause, etiology) for his self-care deficits [remember i said that they are physical, mental or physiological reasons].
what specific kind of infection is the patient at risk for? to us a "risk for" diagnosis you must have some condition in your mind that you think the patient will get in order to write the goals and nursing interventions.
also, "risk for" diagnoses are anticipated problems, not actual problems that the patient has. "risk for" diagnoses are of low priority on the care plan and are listed last. and while we're on "risk for" diagnoses, i would think this patient is a prime target for risk for falls
if he has assistive devices, any peripheral neuropathy from the diabetes, uncontrolled blood sugars, visual problems, incontinence and the fact that he is an amputee.
did i understand correctly that this patient already has mrsa and/or vre? if so, then he already has an infection and is no longer at risk for an infection! if this patient has mrsa or vre he already has an actual problem of an infection. for mrsa and vre you will need to list out the symptoms the patient has and match them to appropriate nursing diagnoses that will apply to them.
and, what did you assess with regard to this patient's diabetes situation? are his blood sugars in control? in he on an appropriate diet? is he following it at home? this may link in to his following a proper medical regime.
you will find information on care planning and choosing nursing diagnoses on these two threads in the nursing student forums: