Nursing Diagnosis Help! Anemia

[Ruba]

My patient just give birth and her hemoglobin is 9.9. How would I write a nursing diagnosis for anemia? Thank you.

[lwhatley]

In addition, I happened to have written a very long term paper in my OB clinical regarding the care of a postpartum patient fairly similar (mainly in that she had a critical H&H)...just to give you some strategy ideas, I'll show you the list of nursing dx's I listed off that applied to my pt...I used this list to pick one specific dx to then complete an extended care plan...have at it yo' see if it inspires you to develop applicable ones for your own pt...

- Activity intolerance r/t fatigue secondary to anemia A.E.B pt report of light headedness, headache, dizziness upon standing.

- Fatigue r/t labor A.E.B physical assessment and patient observation of activity intolerance.

- Sleep Pattern disturbed r/t hospitalization A.E.B observed spurratic sleep pattern and lack of ability to attain adequate sleep.

- Transfer ability, impaired r/t incision secondary to C-section A.E.B facial grimace and refusal to move without pain meds.

- Risk for bleeding r/t birth A.E.B lochia characteristics and clot extraction.

- Cardiac output, decreased r/t anemia A.E.B altered vitals

- Moderate anxiety r/t transfusion indications A.E.B frequent questions of risk.

- Fear of transfusion r/t associated risks A.E.B patient's report.

- Risk for constipation r/t pharmacological therapy A.E.B lack of BM, iron supplement indications, pain medication orders.

- Breastfeeding effective r/t proper training A.E.B successful feeds.

- Anxiety r/t breastfeeding A.E.B lack-of-confidence in ability.

- Risk for electrolyte imbalance r/t anemia and blood loss, A.E.B altered labs.

- Risk for deficient fluid volume r/t breastfeeding A.E.B lack of supplemental intake.

- Comfort impaired r/t hospitalization A.E.B irritability

- Acute Pain r/t birth secondary to c-section A.E.B reports of pain

- Gas exchange impaired r/t anemia secondary to blood loss as evidenced by altered perfusion.

- Risk for imbalanced body temperature r/t loss of blood secondary to birth A.E.B vital sign changes.

- Risk for contamination r/t blood transfusion secondary to critical H&B

- Risk for falls r/t dizziness, fatigue, headache secondary to anemia.

- Risk for infection r/t surgical incision secondary to C-section.

- Risk for infection r/t blood transfusion secondary to critical H&H.

- Risk for injury r/t blood transfusion

- Impaired skin integrity r/t surgical incision secondary to C-section.

- Impaired tissue integrity r/t surgical incision secondary to C-section.

- Knowledge, procedure and risks of blood transfusion, deficient r/t anemia and critical H&H.

[Jmira.BSN.RN]

Here's what I started doing in fundamentals to help me understand the nursing diagnoses.

First you need a strong assessment.

Than go through the entire list of nandas, one by one, and put serious thought into whether or not they would pertain to your patient and why. Really dig into them and use your assessment data to support all of your chosen nandas.

[joanna73, BSN, RN]

Anemia may be caused by various factors, which you would determine through your assessment. Acute hemorrhage, or deficiency of iron, B12 or folate are some examples.

Start by comparing your patient's characteristics to the pathology of various anemias before deciding on a nursing diagnosis. If you don't have a nursing care plan text, invest in one.

We use Nursing Care Plans: Diagnoses, interventions and outcomes. M. Gulanick and J L Myers (8th ed) where I work. Easy to follow and current.

[nurseprnRN, BSN, RN]

See, you are falling into the classic nursing student trap of trying desperately to find a nursing diagnosis for a medical diagnosis without really looking at your assignment as a nursing assignment. You are not being asked to find an auxiliary medical diagnosis-- nursing diagnoses are not dependent on medical ones. You are not being asked to supplement the medical plan of care-- you are being asked to develop your skills to determine a nursing plan of care. This is complementary but not dependent on the medical diagnosis or plan of care.

Sure, you have to know about the medical diagnosis and its implications for care, because you, the nurse, are legally obligated to implement some parts of the medical plan of care. Not all, of course-- you aren't responsible for lab, radiology, PT, dietary, or a host of other things.

You are responsible for some of those components of the medical plan of care but that is not all you are responsible for. You are responsible for looking at your patient as a person who requires nursing expertise, expertise in nursing care, a wholly different scientific field with a wholly separate body of knowledge about assessment and diagnosis and treatment in it. That's where nursing assessment and subsequent diagnosis and treatment plan comes in.

This is one of the hardest things for students to learn-- how to think like a nurse, and not like a physician appendage. Some people never do move beyond including things like "assess/monitor give meds and IVs as ordered," and they completely miss the point of nursing its own self. I know it's hard to wrap your head around when so much of what we have to know overlaps the medical diagnostic process and the medical treatment plan, and that's why nursing is so critically important to patients.

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." No, it's facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological." "Surgery" counts for a physical injury-- after all, it's only expensive trauma. :)

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and related (causative) factor. (Exceptions: "Risk for..." diagnoses do not have defining characteristics, they have risk factors.) Defining characteristics and related factors for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

I know that many people (and even some faculty, who should know better) think that a "care plan handbook" will take the place of this book. However, all nursing diagnoses, to be valid, must come from NANDA-I. The care plan books use them, but because NANDA-I understandably doesn't want to give blanket reprint permission to everybody who writes a care plan handbook, the info in the handbooks is incomplete. We see the results here all the time from students who are not clear on what criteria make for a valid defining characteristic and what make for a valid cause.Yes, we have to know a lot about medical diagnoses and physiology, you betcha we do. But we also need to know about NURSING, which is not subservient or of lesser importance, and is what you are in school for.

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

For this lady, think of how oxygen gets delivered to tissues. What is the difference between a patient with a SpO2 of 95% and a hematocrit of 40 and another one with a SpO2 of 95% and a hematocrit of 20? Who has twice as much oxygen being delivered to her cells? The one who doesn't, what does she look like, why, and what would a nurse observe in her? And then what would the nurse do to make her feel better, or be safer-- nursing interventions, not medical ones?