Scientific rationales for infant with RDS

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Specializes in 5 years/med surg.

Hello Guys,

I am in my 3rd semester(almost done) and I don't feel confident in my care plans as I don't feel the school really helps us master them. However, I was wondering if any one can help me get NIC and Scientific rationale for each of my diagnosis. My instructor wants me to have 3 dx and 3 goals(2 short term and 1 long-term) per diagnosis. My 3 are 1) Neonatal respiratory distress syndrome related to ineffective breathingpattern related to immature lung development as evidenced by expiratory gruntingand nasal flaring, 2) Ineffective thermoregulation r/t increased resp effort. 3) altered nutrition: less than body requirement's r/t increased metabolic needs in the infant. Any suggestions would be appreciate:)

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Don't have my NANDA-I in my lap at the moment, but ... how would increased respiratory effort cause ineffective thermoregulation?

(related to = caused by)

I'm not sure if the others you list appear as approved causes or defining characteristics in the NANDA-I 2012-2014 either, but perhaps you could reassure me if they do.

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Specializes in 5 years/med surg.

Hey THank you,

The other diagnoses are NANDA as Im aware. I'm still working on this care plan too. Any online resources for more detailed help?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
1) Neonatal respiratory distress syndrome related to ineffective breathing pattern related to immature lung development as evidenced by expiratory grunting and nasal flaring, 2) Ineffective thermoregulation r/t increased resp effort. 3) altered nutrition: less than body requirement's r/t increased metabolic needs in the infant. Any suggestions would be appreciated.

What resource are you using for your NANDA?'

Neonatal Respiratory distress syndrome is not a NANDA diagnosis. It would read....ineffective breathing pattern related to immature lung development/gestational age/prematurity. NRDS is a medical diagnosis.

How does an increased respiratory effort affect thermoregulation? Would that not be related to gestational age and other factors as well?

As my freind GrnTea states....

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else.

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Now I'm back at my desk -- been away for a few days. No, 'fraid not.

) Neonatal respiratory distress syndrome related to ineffective breathingpattern related to immature lung development as evidenced by expiratory gruntingand nasal flaring, 2) Ineffective thermoregulation r/t increased resp effort. 3) altered nutrition: less than body requirement's r/t increased metabolic needs in the infant.

Neonatal RDS is not a nursing diagnosis and does not appear in the NANDA-I 2012-2014.

Let us backtrack a little here. Lots of students think that a nursing diagnosis is "a Nanda," but there is no such thing as "a Nanda." NANDA-I is the international organization that identifies and categorizes nursing knowledge, and the ONLY real nursing diagnoses you can use are theirs. Do not rely on "handbooks" or other things that purport to give you nursing dx, because if they do not use the NANDA-I definitions, defining characteristics (or risk factors for risk diagnoses), and related (causative factors) you cannot use them. Why? Because you don't "choose" or "pick" nursing diagnoses because they sound sexy or they sound reasonable to you, and you can't make them up (and neither can anyone else).

Nursing diagnoses, like medical diagnoses, depend on very clear criteria. These are to be found in the NANDA-I 2012-2014, $29 for 2-day delivery at Amazon or $25 for immediate delivery to your iPad or Kindle.

Just as you wouldn't think too much of a physician who meets you and says, definitively, "You're anemic, so we're gonna give you two units of packed cells," without checking your CBC or finding out anything else, you can't think much of a nurse who says, "My nursing diagnosis is ...." without checking for the data required to MAKE the diagnosis (note, not "pick" it). You MAKE a diagnosis based on criteria.("Related to" means "caused by," nothing else, in this context. Yes, you can have a medical diagnosis in the list of related factors. For example, "fracture" is a medical dx, and it's listed as a cause for Pain, duh!)

So... returning to your list. What you have done is say, "My baby patient has neonatal RDS caused by an ineffective breathing pattern and immature lung development, and I know this because I see grunting and flaring."

1) Neonatal RDS is not a nursing diagnosis. If you have observed grunting and flaring in a newborn and an ineffective breathing pattern .... wait!

Ineffective breathing pattern IS a nursing diagnosis (page 233!). But you have to see what defines that before you can make the diagnosis.

Definition: Inspiration and/or expiration that does not provide adequate ventilation.

So far, so good.

Defining characteristics: There are 17 of them, and if your assessment of this baby identifies at least one, you're good to go IF he also has a listed Related (causative) factor. Let's see. Alterations in rate? You don't mention it. Chest excursion? Ditto. Bradypnea? decreased inspiratory or expiratory pressure? decreased minute ventilation? decreased vital capacity? DYSPNEA? (now we're getting somewhere)... NASAL FLARING? ..... more .... USE OF ACCESSORY MUSCLES TO BREATHE?

OK, let's see what related/causative factors this babe might have:

Anxiety (hard to tell c a baby)? Position? Bony or chest wall deformity? Fatigue? Hyperventilation? Hypoventilation syndrome? Musculoskeletal impairment? Neuro damage, dysfunction, or immaturity? Obesity? Pain? Resp muscle fatigue? SCI? Those are your choices. So what is it with this kiddo?

I am not telling you this is the answer, because i don't really know your baby's assessment because you haven't given us much about it. But it COULD be, for example, "Ineffective breathing pattern related to neurological immaturity (prematurity), as evidenced by flaring, dyspnea, and use of accessory muscles to breathe." Maybe not, but see how that works?

You have other choices, like "Ineffective gas exchange (page 214)," defined as "Excess or deficit in oxygenation and/or CO2 elimination at the alveolar/capillary membrane." Defining characteristics are many, but include abnormal ABGs (got any?), ABNORMAL BREATHING, ABNORMAL SKIN COLOR, CYANOSIS in neonates only, NASAL FLARING, and a few other things. Related factors are only two, but they are "alveolar-capillary membrane changes" and "ventilation-perfusion imbalance." If you don't know if your babe has either of those, you can't make your diagnosis, but I'll bet if he's a premie, you could make a case for the first, due to prematurity.

See, that's how it works. You look at the list and think what MIGHT be a decent guess, look at its page, and see if your assessment picked up any of the defining characteristics, and the reasons they might be there are in the chart or in your assessment (related factors). THEN you can make the nursing diagnosis. :anpom:

Now, let's see what you can do with the others. Get the book!

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Specializes in 5 years/med surg.
On 6/12/2014 at 9:31 PM, nurseprnRN said:

Now I'm back at my desk -- been away for a few days. No, 'fraid not.

 

Neonatal RDS is not a nursing diagnosis and does not appear in the NANDA-I 2012-2014.

 

Let us backtrack a little here. Lots of students think that a nursing diagnosis is "a Nanda," but there is no such thing as "a Nanda." NANDA-I is the international organization that identifies and categorizes nursing knowledge, and the ONLY real nursing diagnoses you can use are theirs. Do not rely on "handbooks" or other things that purport to give you nursing dx, because if they do not use the NANDA-I definitions, defining characteristics (or risk factors for risk diagnoses), and related (causative factors) you cannot use them. Why? Because you don't "choose" or "pick" nursing diagnoses because they sound sexy or they sound reasonable to you, and you can't make them up (and neither can anyone else).

 

Nursing diagnoses, like medical diagnoses, depend on very clear criteria. These are to be found in the NANDA-I 2012-2014, $29 for 2-day delivery at Amazon or $25 for immediate delivery to your iPad or Kindle.

 

Just as you wouldn't think too much of a physician who meets you and says, definitively, "You're anemic, so we're gonna give you two units of packed cells," without checking your CBC or finding out anything else, you can't think much of a nurse who says, "My nursing diagnosis is ...." without checking for the data required to MAKE the diagnosis (note, not "pick" it). You MAKE a diagnosis based on criteria.("Related to" means "caused by," nothing else, in this context. Yes, you can have a medical diagnosis in the list of related factors. For example, "fracture" is a medical dx, and it's listed as a cause for Pain, duh!)

 

So... returning to your list. What you have done is say, "My baby patient has neonatal RDS caused by an ineffective breathing pattern and immature lung development, and I know this because I see grunting and flaring."

1) Neonatal RDS is not a nursing diagnosis. If you have observed grunting and flaring in a newborn and an ineffective breathing pattern .... wait!

Ineffective breathing pattern IS a nursing diagnosis (page 233!). But you have to see what defines that before you can make the diagnosis.

Definition: Inspiration and/or expiration that does not provide adequate ventilation.

So far, so good.

Defining characteristics: There are 17 of them, and if your assessment of this baby identifies at least one, you're good to go IF he also has a listed Related (causative) factor. Let's see. Alterations in rate? You don't mention it. Chest excursion? Ditto. Bradypnea? decreased inspiratory or expiratory pressure? decreased minute ventilation? decreased vital capacity? DYSPNEA? (now we're getting somewhere)... NASAL FLARING? ..... more .... USE OF ACCESSORY MUSCLES TO BREATHE?

 

OK, let's see what related/causative factors this babe might have:

Anxiety (hard to tell c a baby)? Position? Bony or chest wall deformity? Fatigue? Hyperventilation? Hypoventilation syndrome? Musculoskeletal impairment? Neuro damage, dysfunction, or immaturity? Obesity? Pain? Resp muscle fatigue? SCI? Those are your choices. So what is it with this kiddo?

 

I am not telling you this is the answer, because I don't really know your baby's assessment because you haven't given us much about it. But it COULD be, for example, "Ineffective breathing pattern related to neurological immaturity (prematurity), as evidenced by flaring, dyspnea, and use of accessory muscles to breathe." Maybe not, but see how that works?

 

You have other choices, like "Ineffective gas exchange (page 214)," defined as "Excess or deficit in oxygenation and/or CO2 elimination at the alveolar/capillary membrane." Defining characteristics are many, but include abnormal ABGs (got any?), ABNORMAL BREATHING, ABNORMAL SKIN COLOR, CYANOSIS in neonates only, NASAL FLARING, and a few other things. Related factors are only two, but they are "alveolar-capillary membrane changes" and "ventilation-perfusion imbalance." If you don't know if your babe has either of those, you can't make your diagnosis, but I'll bet if he's a premie, you could make a case for the first, due to prematurity.

 

See, that's how it works. You look at the list and think what MIGHT be a decent guess, look at its page, and see if your assessment picked up any of the defining characteristics, and the reasons they might be there are in the chart or in your assessment (related factors). THEN you can make the nursing diagnosis. :anpom:

 

Now, let's see what you can do with the others. Get the book!

This is most definitely an amazing but detailed, and clear explanation for my question. Although I have not been on my account for a long long time I appreciate and am grateful you took time to answer. I did not get a prompt to my phone that someone responded and I got extremely busy so I really forgot to check back this forum.

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