A problem with Nursing dg....

by fitore fitore Member

Im witting a ncp- stroke and I have some prob,,, if anyone can help me I will be very very grateful, cos I need an answer quickly......

I want to know if I have properly aligned those nursing dg,

Impaired brain tissue perfusion related to intracerebral hemorrhage. (Marilynn E. Doenges, 2000)

Impaired physical mobility related to hemiparese / hemiplegia (Donna D. Ignativicius, 1995)

Impaired sensory perception related to sensory impairment, vision impairment (Donna D. Ignativicius, 1995)

Impaired verbal communication related to the decrease in brain blood circulation (Donna D. Ignativicius, 1995)

Impaired elimination (constipation) related to immobilization, inadequate fluid intake (Donna D. Ignativicius, 1995)

Impaired elimination urine (urine incontinence) related to lesions in the upper motor neuron (Juall Lynda Carpenito, 1998

. Disturbed Thought Process.

. Ineffective Coping. Management of stroke requires a strong need for healthy lifestyle or change, this may be difficult for the patient.

selfcare deficit higjena dressing. grooming and feeding due to neuromudcular impairment

Deficient Knowledge

. Disturbed Sleep Pattern

Risk for impaired swallowing

The risk of nutritional deficiencies related to muscle weakness of chewing and swallowing (Barbara Engram, 1998)

.Risk for Aspiration. This is due to depressed or absent cough reflex due to infarction of a brain area.

Risk for Hyperthermia. This may be due to bleeding or edema of the hypothalamus which can lead to ischemia and thus changes in the thermoregulatory center of the brain.

The risk of disruption of skin integrity related long bed rest (Barbara Engram, 1998)

. Risk of Injury

Edited by Esme12

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

Since the care plan depends on the pateints assessment and you need to know wha tis priority for the pateint......What is you assessment?

Here is what I know.....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 assessment. 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.

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.

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. I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition

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. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. 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)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

To prioritize.......think Maslows. these are prioritized according to think Maslow's hierarchy of needs. maslow's hierarchy of needs - enotes.com virginia henderson's need theory

Maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

  • self-actualization – e.g. morality, creativity, problem solving. (to be filled last)
  • esteem – e.g. confidence, self-esteem, achievement, respect.
  • belongingness – e.g. love, friendship, intimacy, family.
  • safety – e.g. security of environment, employment, resources, health, property.
  • physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis. (greatest need to be filled first)


  • maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

  • the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
  • growth needs are the highest level, which is self-actualization, or the self-fulfillment.
  • maslow suggested that only two percent of the people in the world achieve self actualization. e.g. Abraham Lincoln, Thomas Jefferson, Albert Einstein, Eleanor Roosevelt.
  • self actualized people were reality and problem centered.
  • they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
  • they tended to be spontaneous and simple.

application in nursing

  • maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.



49 Posts

i get it but, can anyone explain ( tell with other words- siple words) this sentences cos i have problems with english so I'm stuck ....

Support coping process and integration of changes into self-concept.

Start to order a progressive ambulation aids to sit in a balanced position from the procedures to move from bed to a chair to reach equilibrium.

Assess the functional type as the patient does not seem to understand the words or have difficulty speaking / making sense of their own.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

Support coping process and integration of changes into self-concept. You will help the patient adjust to their new limitations.....like being paralyzed into their life and help them adjust and like themselves again.

Start to order a progressive ambulation aids to sit in a balanced position from the procedures to move from bed to a chair to reach equilibrium. Help the patient learn how to sit up, get up even though they are paralyzed so they know how to sit upright in a chair again.

Assess the functional type as the patient does not seem to understand the words or have difficulty speaking / making sense of their own. Find a way to communicate with and allow the patient to learn how to communicate their needs when they have lost the ability to speak and let their needs be known.

I hope this helps.....where are you from???



49 Posts

I was searching in google, for more information about ncp- stroke, when I saw this web site, and only now I have started to understand better nursing process. I know that books would help me to do a plan care , but here we dont have those books.

Im from southeastern Europe- Western Balkans.

Nursing faculty has begun only a few years ago and unfortunately our teachers are not as prepared professionally.also we do not have adequate literature, they only teach us some things that they translate from English or German.

And I have another question:

Implementation- in which tense must be written. In Past tense or in future tense.


the Nurse will Monitor vital signs or

the Nurse monitored vital signs

  • The Nurse will Maintain , will create a peaceful environment, limit the activities of visitors.
  • Nurse have maintained a peaceful environment, and have limited the activities of visitors.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

The Nurse will Maintain , will create a peaceful environment, limit the activities of visitors.

Once you get 15 posts you can PM members.....there is also a search box in the upper right corner....type in what you are looking for and it will search the site.

check here




49 Posts

I saw a post by Daytonite and i was wondering if I get it:


1.... outcomes:

1) patient will eat food safely.

2) patient will be more independent when eating meals

3) patient will consume more food at meals


make sure utensils and cups are within reach of the patient's right arm and encourage patient to eat using the right arm.

3.......rationale: this allows independence and increases a sense of self-esteem.

- 4.......effectiveness: patient felt comfortable eating, and was able to eat to his meal with more ease

i think that :

1........ is Planning

2........ is Planning ( Interventions)

3......is implementation

4.......is evaluate

tell me if im right



49 Posts

Thanks, it was a very good way to explain, ncp



49 Posts

I almost understand all the process, but I have more things that I would like to ask, I have done with assesment, nursing diagnosis, and planning . In Planing phase I have written which are nursing Priorities, Nursing outcomes, and Nursing interventions.

But : should I put RATIONALE, into Planing Phase, or Rationale belongs to Implementation ?