Nursing Diagnosis/Medical Diagnosis Question :)

  1. 0
    I have a 73 yo male pt who was admitted on the unit with a medical diagnosis of osteomyelitis. He subsequently had his L 5th toe amputated. Concurrent medical diagnoses are DM, CVD and COPD.

    I am unsure if I should use osteomyelitis or L toe amputation for the medical diagnosis to base my nursing diagnoses on. There's no longer an infection of the bone. That problem was eliminated with the amputation so I am hesitant to use this. My nursing care interventions are all based upon the amputation itself with his inability to ambulate, self care deficit and pain management.

    Since amputation was the treatment for the osteomyelitis I'm not even sure that is a valid medical diagnosis.

    What would you recommend?
  2. 9 Comments so far...

  3. 1
    Just my two cents - I would tie the nursing diagnosis (e.g. impaired physical mobility) to the treatment (amputation) of the medical condition (Osteomyelitis):

    Impaired physical Mobility r/t amputation of toe d/t Osteomyelitis.
    rubato likes this.
  4. 0
    Since he no longer has an infection, the osteomyelitis is resolved; think of it like that. It is still his dx, BUT it is simply resolved via the amputation. If you have already formulated a nursing dx addressing impaired ambulation then I wouldn't repeat that.

    Let me help you think about this with some questions to ask yourself, because I know you know the answer.
    1.) Was this amputation recent? Is it still healing? Would that mean he is at risk for anything? Does he have any current Dx's that further this risk?

    2.)Given that he will have an obvious gait impairment, what does that in turn put him at risk for?

    3.)As with all amputees (big or small), have you considered psychosocial? (of course that will be lower priority- Maslows)
    Speaking of Maslow's, don't forget about him.

    Let me know what you come up with!
  5. 0
    There could also be issues with skin integrity, pain, circulation, and infection with the amputation and previous osteomyeltitis. All possible nursing dxs. You could include amputation secondary to osteomyelitis to maintain that medical dx.
  6. 0
    Quote from Nursing_Mamacita
    Since he no longer has an infection, the osteomyelitis is resolved; think of it like that. It is still his dx, BUT it is simply resolved via the amputation. If you have already formulated a nursing dx addressing impaired ambulation then I wouldn't repeat that. Let me help you think about this with some questions to ask yourself, because I know you know the answer.

    1.) Was this amputation recent? Is it still healing? Would that mean he is at risk for anything? Does he have any current Dx's that further this risk? 2.)Given that he will have an obvious gait impairment, what does that in turn put him at risk for?

    3.)As with all amputees (big or small), have you considered psychosocial? (of course that will be lower priority- Maslows) Speaking of Maslow's, don't forget about him.

    Let me know what you come up with!
    THIS...you are on the right track.
  7. 1
    Quote from Jamie1985
    I have a 73 yo male pt who was admitted on the unit with a medical diagnosis of osteomyelitis. He subsequently had his L 5th toe amputated. Concurrent medical diagnoses are DM, CVD and COPD.

    I am unsure if I should use osteomyelitis or L toe amputation for the medical diagnosis to base my nursing diagnoses on. There's no longer an infection of the bone. That problem was eliminated with the amputation so I am hesitant to use this. My nursing care interventions are all based upon the amputation itself with his inability to ambulate, self care deficit and pain management.

    Since amputation was the treatment for the osteomyelitis I'm not even sure that is a valid medical diagnosis.

    What would you recommend?
    I would recommend that you base your nursing diagnoses on your assessment of your patient and not on his medical diagnoses. Nursing diagnoses are not based on medical diagnoses. I'm sure either Esme or GrnTea will be along shortly to explain this further.
    psu_213 likes this.
  8. 0
    Welcome to AN! The largest online nursing community!

    What semester are you? What care plan book do you use?

    YOu are falling into the trap that many students fall into....choosing your diagnosis then fitting the patient into it. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

    What is your assessment? What are the vital signs? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. What is YOUR scenario? TELL ME ABOUT YOUR PATIENT...

    The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

    Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

    Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

    Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

    Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

    Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

    1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
    2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
    3. Planning (write measurable goals/outcomes and nursing interventions)
    4. Implementation (initiate the care plan)
    5. Evaluation (determine if goals/outcomes have been met)

    Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

    Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

    A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

    What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

    Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

    So tell me about your patient
    .......What do they need? What do they c/o? What is your assessment......What does this tell me about the patient?
  9. 1
    Quote from KelRN215
    I would recommend that you base your nursing diagnoses on your assessment of your patient and not on his medical diagnoses. Nursing diagnoses are not based on medical diagnoses. I'm sure either Esme or GrnTea will be along shortly to explain this further.
    Actually, it is a fallacy that a nursing diagnosis cannot ever be "based on" a medical diagnosis. Many nursing diagnoses have related-to's (causative factors) that are medical diagnoses. For example, just flipping my book open here, on page 476 of the NANDA-I 2012-2014 I find Nausea. There are a number of related factors which are medical diagnoses, e.g., Meniere's, meningitis, labyrinthitis, increased intracranial pressure, intracranial tumor or hemorrhage ... and more.

    What you can't do is say, "My patient has X medical diagnosis, so I need three nandas for that."
    First, there is no such thing as "a nanda," I don't care what terms you can search on the web. That's ignorance speaking. Stop that right now!

    Second, while if I admit somebody with, say, diabetes, I can think right off the top of my head of a number of possible nursing diagnoses I might diagnose in this person. Think of them as differential diagnoses, to use a medical parallel. I might see things like changes in mobility due to peripheral neuropathy or CHF or amputation or stroke, I might see shortness of breath from CHF, I might see low hematocrit due to renal failure, I might see complete ignorance about self-care management, I might see nausea due to gastroparesis or uremia, I might hear about sexual dysfunction due to arterial disease ... all of these, and many more, I might keep in the back of my mind while I assess THIS patient in front of me. But I cannot say, "This patient has diabetes, so therefore he has ineffective sexuality pattern, impaired mobility, activity intolerance, ineffective tissue perfusion, and knowledge deficit." Maybe he has some, all, or none of these. I have to do my due diligence to assess him before I can make a diagnosis, just as a physician has to do due diligence to make a medical diagnosis.
    phdewer84 likes this.
  10. 0
    Very cute
  11. 1
    Quote from 2013SNGrad
    Very cute

    What's very cute? Could you clarify?

    If you wish to quote a particular post, hit the "Quote" button on the lower right corner of the post. You can cut parts that you don't want to highlight after it appears in the new window.
    psu_213 likes this.


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