Priority nursing diagnosis for anemia in labor/birth

Esme12, ASN, BSN, RN · Sep 20, 2013

As I begin every help session.....care plans are all bout the patient assessment.....Tell me bout your patient...what do they need?

ixchel · Sep 20, 2013

As I begin every help session.....care plans are all bout the patient assessment.....Tell me bout your patient...what do they need?

This may be a more concrete and concise answer than you are hoping for, but she needs to get her h&h back to normal. I'm stuck on what the most important reason WHY she needs that is, though. I think if I can get my head wrapped around that, the nursing diagnosis will slap me right in the face. I can think through the patho of anemia, and I *think* what she needs is perfusion first. But not just of one area (cardiac, vs renal, vs peripheral). I really dislike nanda diagnoses because I will have the best idea in my head for something, but we're require to use these diagnoses to the letter and sometimes they don't fit.

ixchel · Sep 20, 2013

I may have just discovered my answer. This book only has only one ACTUAL ineffective tissue perfusion diagnosis and it is for peripheral. The rest are risk for. It also lists edema as a defining characteristic, which she had. I think I will go with that one, unless you are feeling very strongly against that idea, or if you have something that fits a lot better than this.

wantccu · Sep 20, 2013

Did she have a c or episiotomy? That could be a why. You need a good perfusion to heal and avoid infection. Without knowing details, that's where my mind would go. But, I'm a student as well and there are a lot of people on here that know a lot more than me!! :)

ixchel · Sep 20, 2013

Did she have a c or episiotomy? That could be a why. You need a good perfusion to heal and avoid infection. Without knowing details that's where my mind would go. But, I'm a student as well and there are a lot of people on here that know a lot more than me!! :)[/quote']
She did have a 2nd degree tear. Thank you - I hadn't thought about that. There is no such thing as "just a student" ?

Esme12, ASN, BSN, RN · Sep 20, 2013

This may be a more concrete and concise answer than you are hoping for, but she needs to get her h&h back to normal. I'm stuck on what the most important reason WHY she needs that is, though. I think if I can get my head wrapped around that, the nursing diagnosis will slap me right in the face. I can think through the patho of anemia, and I *think* what she needs is perfusion first. But not just of one area (cardiac, vs renal, vs peripheral). I really dislike nanda diagnoses because I will have the best idea in my head for something, but we're require to use these diagnoses to the letter and sometimes they don't fit.

But how low is her H&H....is she orthostatic? Did she hemorrhage during delivery? The issue here is picking a diagnosis and fitting your 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 let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Esme12, ASN, BSN, RN · Sep 20, 2013

I may have just discovered my answer. This book only has only one ACTUAL ineffective tissue perfusion diagnosis and it is for peripheral. The rest are risk for. It also lists edema as a defining characteristic, which she had. I think I will go with that one, unless you are feeling very strongly against that idea, or if you have something that fits a lot better than this.

I can't help you find a diagnosis without an assessment about THE PATIENT. Without patient assessment a NURSING diagnosis cannot be found.

What is the blood count...what make you think they are anemic? What is the patients baseline? Are you sure the edema is from anemia or from the pregnancy itself or a pre-eclampsia toxemia. MANY women at the end of their pregnancies have some edema.

If you are looking at anemia...what kind of anemia? What made you choose anemia as your focus?

NANDA describes ineffective tissue perfusion as: a Decrease in blood circulation to the periphery that may compromise health

The defining characteristics (supporting evidence) are......Absent pulses; altered motor function; altered skin characteristics (color, elasticity, hair, moisture, nails, sensation, temperature); blood pressure changes in extremities; claudication; color does not return to leg on lowering it; delayed peripheral wound healing; diminished pulses; edema; extremity pain; paresthesia; skin color pale on elevation

The ineffective tissue perfusion is related to....Related Factors (r/t):

Deficient knowledge of aggravating factors (e.g., smoking, sedentary lifestyle, trauma, obesity, salt intake, immobility); deficient knowledge of disease process (e.g., diabetes, hyperlipidemia); diabetes mellitus; hypertension; sedentary lifestyle; smoking

Describe to me.......How does you patient assessment support this information?

Esme12, ASN, BSN, RN · Sep 20, 2013

She did have a 2nd degree tear. Thank you - I hadn't thought about that. There is no such thing as "just a student" 

A second degree tear in and of itself won't cause anemia. I really want to help but I can't without you telling me about this patient and why you are focused on anemia.

ixchel · Sep 20, 2013

A second degree tear in and of itself won't cause anemia. I really want to help but I can't without you telling me about this patient and why you are focused on anemia.

The difficulty I am having is that the anemia is what my instructor is wanting me to focus on for my priority diagnosis, and she is the one grading this. If you want to know the truth, I did not see anything beyond the h&h being low to indicate that anemia is even a priority for this patient right now, but since my instructor is saying that this actual problem is being presented, I have to pick that as my prioritie. My patient did not describe any adverse effects occurring as a result of her anemia, so I have no subjective data to support this diagnosis, and the only objective data I have to support it is the h&h being low. (9.6/28.3 in July, 10.7/32.6 at labor admission, the improvement likely from supplementation)

If I were to choose the priorities on my own, I would say #1 is risk for bleeding related to postpartum hemorrhage, #2 ineffective breathing pattern related to adjustment to extrauterine existence (the neonate had high respirations immediately after birth and still had peripheral cyanosis more than 10 minutes after birth), and #3 acute pain related to physiologic response to labor (she was well managed with her epidural but experienced breakthrough pain while crowning). I wouldn't put anemia until much further down the list because she appeared to be tolerating it well, evidenced by lack of fatigue, lack of paleness, lack of developmental issues with baby, etc. I shared some of this with my instructor, but she feels that this actual diagnosis needs to be at the top because it is actual, even though I really don't have the supporting info to back that choice up now that I am sitting here trying to think this through and getting stuck. So therein lies why I am trying to make the diagnosis fit the patient.

P.S. The tear wont cause anemia, however, the anemia may delay healing, which is what I was thinking on that one.

ixchel · Sep 20, 2013

Okay, I just emailed the professor. The thing is, I do have care plan books. Two actually. If I am going to do this right, I need to just step up and say listen.... anemia isn't the priority here. So I wrote to her, backed up all that I had to say, and hopefully she's on the same page.

Thank you, Esme, as always

Esme12, ASN, BSN, RN · Sep 20, 2013

Your teacher.....Ok....that explains volumes.....the body goes through significant changes with pregnancy. The amount of blood in the body increases by about 20-30 percent, which increases the supply of iron and vitamins that the body needs to make hemoglobin. Many women lack the sufficient amount of iron needed for the second and third trimesters. When your body needs more iron than it has available, they can become anemic.

Mild anemia is normal during pregnancy due to an increase in blood volume. More severe anemia, however, can put the baby at higher risk for anemia later in infancy. If the patient is significantly anemic during the first two trimesters, there is a greater risk for having a pre-term delivery or low-birth-weight baby. Being anemic also burdens the mother by increasing the risk of blood loss during labor and making it more difficult to fight infections....and in turn will delay healing.

But would that be......impaired tissue integrity and delayed recovery.

Impaired Tissue Integrity

Definition:Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues

Defining Characteristics

Damaged tissue (e.g., cornea, mucous membrane, integumentary or subcutaneous tissue); destroyed tissue

Related Factors (r/t)

Altered circulation; chemical irritants; fluid deficit; fluid excess; impaired physical mobility; knowledge deficit; mechanical factors (e.g., pressure, shear, friction); nutritional factors (e.g., deficit or excess); radiation; temperature extremes

or maybe....

Delayed "surgical" (especially if there is m episiotomy) recovery: Extension of the number of postoperative/post delivery days required to initiate and perform activities that maintain life, health, and well-begin