psych nursing diagnosis, care plan?

RN BSN 2009 · Apr 6, 2008

My pt. has schizoaffective disorder, learning disabilities, GERD and insulin-dependent diabetes - not sure type 1 or 2. Hospitalized after acute manic episode, intrusive suicidal thoughts - low risk for suicide, does not want to die, has plans for future, called EMS herself and has done it before on numerous occasions. Was being released next day. Did not strike me as attention-seeking.
Although BS was 161 in hospital, pt. reports 300-500 at home, has peripheral neuropathy and retinopathy at age 35. Pt. claims to check BS 4x day and manage sliding scale.
I want to use "ineffective therapeutic regimen management" as a priorty ND, as poor BS control can certainly lead to emotional and cognitive disturbances and threatens her ability to work - she reports finances as THE major stressor her life at this time. I suspect she may not be adhering to her PO meds either - she is on 6 psych meds, Zocor and Protonix. She is very willing to be compliant, very eager to please, was home health aide in past.
I believe her trouble managing the meds stems from the learning disability and disorganized thinking but how do I put that as a "related to"?
Short term intervention: assess her ability to use a sliding scale insulin. Teach according to results.
Long term intervention: Collaborate with patient on planning medication regimen - weekly 2x day pill box, what are her cues to take meds, charting meds, BS and insulin dose, who will review her charts with her, chart diet if pt is willing.
Will this work?

When you are having trouble figuring out a priority diagnosis, think of your ABC's (airway, breathing and circulation) and maslow's hierarchy, that will point you in the right direction

Your related to cannot be a medical diagnosis but the effects of the diagnosis... Good luck

birdgardner · Apr 6, 2008

Pt. isn't having ABC issues - except for long term risk to circulation from diabetes.

Pt. is stabilized in hospital, soon to be discharged and very low suicide risk at this time.

Pt. needs to stay stable and manage diabetes. Therefore "Ineffective therapeutic regimen management" strikes me as the priority to address at this time. Yes?

And I will use "cognitive difficulties" rather than "learning disability" in r/t.

Daytonite, BSN, RN · Apr 6, 2008

you are the third student wanting to use this diagnosis this week! this is a tricky one. you need to read the nanda information about it carefully so you understand what this problem is. you cannot diagnose your patient with this problem based upon your suspicions. ineffective health maintenance is an actual problem. if you don't have the data to support this as being an actual problem then consider making it a risk for ineffective health maintenance and read the post on https://allnurses.com/forums/f50/help-care-plans-286986.html about potential ("risk for") diagnoses

here is information about ineffective health maintenance:

the description of the problem "ineffective health maintenance" is defined by nanda as the

inability

to identify, manage, and/or seek out help to maintain health.

the keyword in this definition is "inability".

inability

means unable, incapable, powerless, incompetent, or no skill at. with

ineffective health maintenance

the patient may not know/understand why they are not able to follow the plan of care, may not care, or may not mentally or physically be able to. the bottom line reason, or etiology, for their

inability

to identify, manage, and/or seek out help to maintain health

is what becomes the r/t part of the diagnostic statement. so you need to think back through what you learned about this patient. what is the

bottom line cause

for their failure to follow the medical plan of care?

what supports and proves the patient isn't maintaining their health is the evidence, or data, you collected and it becomes the aeb part of the diagnostic statement. this part of your nursing diagnostic statement is evidence (symptoms, defining characteristics) that are proof that the patient isn't able [capable, has the power, is incompetent, or lacks the skill] to identify, manage, and/or seek out help to maintain their health. not showing any interest or concern in knowing about medications, information about their disease process and what should be done to support good health practices for it are indicators of evidence for this diagnosis. this is the guidance that nanda gives us for the symptoms (aeb items) you should be looking for and have to support this nursing diagnosis:

history of lack of health-seeking behaviors [misses appointments, doesn't take medication or perform treatments on a regular basis]
inability to take responsibility for meeting basic health practices [this would be blaming others/passing the buck]
lack of expressed interest in improving health behaviors [statements like: "it's not going to make any difference if i take my medicine or not."]
demonstrated lack of knowledge regarding basic health practices ["mama always taught us to (do some bizarre thing to cure a fever)"]
demonstrated lack of adaptive behaviors to environmental changes

here is a webpage that has the nanda information and some goals and nursing interventions (although they may not apply to this patient) for this diagnosis:

[color=#3366ff]ineffective health maintenance

.

your interventions sound ok, but you had to have evidence supporting the problem first which you determined during your assessment to address these specifically and come up with these strategies. however, your post indicates that you couldn't determine that information. so, i have to wonder if you are starting with a final result (interventions) and then trying to somehow make your critical thinking fit in (tack on a related factor). the problem solving in the care plan should follow the step by step sequence of the nursing process.

the steps of the nursing process are:

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)
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)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

amybethf · Apr 6, 2008

I am in my psych rotation and the NANDA priority is always safety first then physiological. Daytonite's advice as usual is right on the money!

birdgardner · Apr 8, 2008

thanks esp to daytonite risk for ineffective health maintenance sounds perfect