you've got some major problems with your diagnosis and the construction of your diagnostic statement. . .
fluid volume deficit related to decreased intake as evidenced by constipation, he pt. has cancer of the prostate
fist let me break down the construction of your 3-part diagnostic statement and go through it with you piece by piece:
p (problem, nursing diagnosis label)
: fluid volume deficit
- the actual wording by nanda is deficient fluid volume
, but use what your instructors direct you to use
e (etiology of the problem, related factor[s])
: decreased intake
- the definition of deficient fluid volume
(the true nursing problem you are targeting here) is: decreased intravascular, interstitial, and/or intracellular fluid. this refers to dehydration, water loss alone without change in sodium. (page 90, nanda-i nursing diagnoses: definitions & classification 2007-2008). it is not decreased intake. decreased intake is a problem of the patient not taking in enough fluid (and food?). if this is what is going on then your patient's nursing problem is a nutrition or feeding self-care deficit one. dehydration is a medical problem--we are nurses and we do not treat medical problems, only the patient's response to them. so, i'm now wondering if you have diagnosed this patient incorrectly with deficient fluid volume.
s (symptoms, defining characteristics)
: constipation, the pt. has cancer of the prostate
- a symptom is an objective observation you
or someone else has made or a subjective perception made by the patient that serves as supporting evidence proving that the problem exists (see "p") - this evidence comes from the initial assessment that you have done of the patient that involves.
- collecting data from the patient's medical record
- doing your own physical assessment of the patient
- assessing the patient's ability to perform adl's (activities of daily living) which include such things as bathing, dressing, walking, eating, toileting, grooming, ability to move and get where they need to go, communicate, sleep, and participate in diversional/social activities
- looking up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - you need to know pathophysiology in order to understand the etiological links between nursing problems and medical diseases
while i understand that constipation can be a result of decreased fluid intake, it is, nevertheless, not a symptom of dehydration. if this patient is constipated, that is another problem and there is a nursing diagnosis you should use to address that (constipation).
cancer of the prostate is a medical disease.
- medical diseases can not be used in nursing diagnoses
- a medical disease is not a symptom since it is not an objective observation. it is a decision made by a physician.
therefore, you cannot use it as supporting data (evidence) of deficient fluid volume
either. so, you are now stuck with no evidence to support this nursing diagnosis, and a very weak premise to even diagnose the patient with water loss that is causing dehydration.
my recommendation is that you go back through the assessment data you collected. do some investigation of what dehydration is and see if you missed some of the symptoms of it in your patient. this is how you are going to improve and learn. now is the time to make the corrections and add those symptoms you might have missed to your collection data. then, re-diagnose. it is a good idea to use a nursing diagnosis reference to assure that you are diagnosing correctly. you need a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
- your instructors might have given it to you.
- you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
- many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
- there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
every nursing diagnosis, just like every medical diagnosis, has a list of signs and symptoms. the nanda terminology for these signs and symptoms of the nursing diagnoses is defining characteristics
.you can see the list of defining characteristics for deficient fluid volume
on this web page: [color=#3366ff]deficient fluid volume
. check it to see if your patient didn't have some of these symptoms if she was diagnosed by the doctor with dehydration. you should also do a search on the internet and in your textbooks for other symptoms of the medical condition of dehydration to educate yourself. you will have a lot of patients admitted with dehydration in addition to their other medical problems they will have, so it would be a good idea to learn about it.
these threads on allnurses have information on care plans