we are helped in prioritizing needs by using maslow's hierarchy of needs (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs
). the physiological needs come before the safety needs. hyperglycemia and uncontrolled diabetes are actually medical conditions rather than nursing needs. frequent falling is a nursing need that involves the patient's safety.
one of the major differences between medical diagnoses and nursing diagnoses, which are actually nursing problems, is that nursing problems focus on the patient's response to their medical condition(s). since hyperglycemia and uncontrolled diabetes are medical conditions that need to be turned into nursing needs (problems) what has to be done is the patient's response to these conditions must be examined and considered in order to determine where the persons nursing needs (problems) in relation to them lies. actually, one of the manifestations of uncontrolled diabetes would be hyperglycemia (elevated blood sugar). what you must do is research diabetes and hyperglycemia. look up the signs and symptoms of untreated diabetes (that is what uncontrolled diabetes is) and hyperglycemia. they proceed in a specific sequence that will give you a priority of treatment. they will all be physiological needs that will take priority over the frequent falling.
this patient also has hemiparesis as a result of his stroke which has most likely resulted in a mobility problem and is responsible for the falls. in looking up information about strokes you would discover this:
nursing home care is primarily to assist patients with their self-care deficits after their medical conditions, which are stable, have been addressed.
now, i would tell you to begin this assignment again by using the nursing process. start by making an assessment of this patient which will include looking up information about strokes, hemiparesis, diabetes and hyperglycemia and maybe even pneumonia. extrapolate possible self-deficits that people are likely to have as a result of these conditions that would put them in a nursing home. make a list of the signs and symptoms of the diseases. what nursing diagnoses will apply? now, what top three rise to the top in priority?
here are the steps of the nursing process for care planning:
- assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
- a physical assessment of the patient
- assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
- data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
- knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
- 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). it helps to have 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.
- the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
- there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
- planning (write measurable goals/outcomes and nursing interventions)
- goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
- improve the problem or remedy/cure it
- stabilize it
- support its deterioration
- how to write goal statements: http://allnurses.com/forums/2509305-post158.html
- interventions are of four types
- assess/monitor/evaluate/observe (to evaluate the patient's condition)
- note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
- care/perform/provide/assist (performing actual patient care)
- teach/educate/instruct/supervise (educating patient or caregiver)
- manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
- implementation (initiate the care plan)
- evaluation (determine if goals/outcomes have been met)