Nursing Dx ?

[Neats, BSN]

I am unsure which Nursing DX to use for my client who has Hx of DKA.

Noncompliance r/t knowledge deficit or Ineffective coping r/t inability to understand

Client HX: IDDM 20yr, has Hx bi-polar and multiple DKA's with one episode so severe resulted in some brain damage (this is why I consider Ineffective coping)

Client is receptive to teaching and can verbalize, and demonstrate instruction back to you when being taught about diabetes control, (this is where I think non compliance)

I have alot of client info just need guidance as to nrsg Dx

Can anyone please give this student nurse some guidance as to which Nursing Dx to use?

Thank you all in advance for your words of wisdom.

[PsychNurseWannaBe, BSN, RN]

Hi,

If you want to address the issue that he is having relapses because he is unable to implement DM management into his lifestyle, consider:

Ineffective Therapeutic regimen management

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

Take care,

~Psych

[Daytonite, BSN, RN]

the answer to your question lies in the careful reading the definition, defining characteristics and related factors of the nursing diagnoses you are contemplating using. it is in that information that the intention of each nursing diagnosis becomes clear. it sounds like this patient might have a cognitive deficit of some type--perhaps some brain damage that is at the root of their inability to manage their disease which would be the underlying etiology, or related factor for why they keep coming in with dka. that will greatly affect the nursing diagnosis you use. do they make these mistakes in the management of their disease deliberately (noncompliance) or is the patient (excuse the use of the wording) just dumb about it in which case deficient knowledge r/t to cognitive limitation aeb [look at the defining characteristics for this diagnosis - [color=#3366ff]deficient knowledge (specify)]. . . so that would probably work. look very carefully at the related factors listed under noncompliance because it doesn't sound like they necessarily fit with this patient.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=36

take a look at this recent thread on a patient with dka: https://allnurses.com/forums/f50/nursing-dx-dka-patient-259280.html - nursing dx for dka patient. this is about a patient admitted with dka who took regular insulin after running out of her 70/30 insulin and ended up in the hospital with dka. a whole different nursing diagnosis was found to use.

[Neats, BSN]

Thank you for the wonderful replies. I decided to go with Risk prone health behaviors. This Dx fits the clients s/s most. Daytonite I have learned so much from reading your replies to this and other questions. If you are not an instructor/mentor at your facility it is their loss. Thank you for sharing your nursing experiences on allnurses.

[PsychNurseWannaBe, BSN, RN]

Client is receptive to teaching and can verbalize, and demonstrate instruction back to you when being taught about diabetes control, (this is where I think non compliance).

If the client is as stated above, then I don't see a cognitive problem necessarily. Unless once you teach him, he actually forgets how and why to perform what you taught... such as with a memory deficit (for example). Since the patient can demonstrate, then it isn't a psychomotor skill issue. If the how and why are there, then Deficient Knowledge no longer fits as a primary but more of a related to (Carpenito, 2002). Therefore I would agree with a knowledge deficit, but I would put it as a r/t factor.

Ineffective Therapeutic Regimen Management r/t lack of knowledge of diabetes mellitus, management, and signs and symptoms of complications AEB inability to manage disease process and multiple DKA admissions.

This leads me to thinking that at times it is splitting hairs. You can present your patient to 3 different nurses and you will get 3 different diagnoses. I have seen this happen many times with nurses. They go 'round and 'round. The kicker is that they almost always agree with the interventions. So I don't get stuck on word play as long as our actions are where they should be.

I just wanted to explain my rationale for my initial post.

Thanks