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Antepartum nursing diagnosis

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by ladysyrah ladysyrah (Member) Member

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So I have a primigravida patient who has completed full prenatal care. Has a medical background. Rh negative. SROM. Clear fluid. Late 20's. GBS negative. 37w6d. I have to figure out 3 antepartum* NANDA nursing diagnoses for this patient. It says specifically that it cannot be intrapartum. So far these are my thoughts but I am questioning my self, so any help would be greatly appreciated!

Risk of Maternal Injury R/T Rh incompatibility

Knowledge deficit R/T primigravida

I was thinking of doing something r/t cardiac output or increased blood volume but cannot think of how to put it together.

Thank you in advance!

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53 Posts; 1,069 Profile Views

Disturbed sleep pattern r/t shortness of breath and urinary frequency?

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1,035 Posts; 6,849 Profile Views

OK, let's see if we can't tease this out. You don't have to come up with anything originally here, because, lucky for you, the profession of nursing is evidence-based and all the validated related (causative) factors are easily available in the pages of the single authority for making (not choosing: or "picking") nursing diagnoses: The NANDA-I 2015-2017 (this is the current edition-- it's updated q 2 years).

 

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there.
Nursing diagnosis does NOT result from medical diagnosis, period. As physicians make medical diagnoses based on evidence, so do nurses make nursing diagnoses based on evidence.

 

 

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

 

 

You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data.

 

 

This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

 

 

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

 

 

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological.” Surgery is a physical injury agent, right? So is a burn or a fracture, right? These are medical diagnoses which cause pain.

 

 

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2015-2017 (current edition). $39 paperback, $23 for instant download to your Kindle at Amazon, free 2-day delivery for students. This edition also includes an EXCELLENT FAQs section aimed at students.

 

 

NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

 

 

If you do not have the NANDA-I 2015-2017, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilation...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

 

 

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. CONGRATULATIONS! You made a nursing diagnosis! th_bf-swinging-00 If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

 

 

About Risk for” diagnoses:

First: "Risk for" nursing diagnoses are very often properly placed first, as safety ranks above all of the physiological needs in Maslow's hierarchy. Faculty often ask specifically for a ranking in Maslow's hierarchy. What are nurses for if not to protect a patient's safety, first and foremost?

 

 

Second:
It is a fallacy that "risk for..." nursing diagnosis is somehow lesser or not "real." If you look in your NANDA-I 2015-2017, there is a whole section on Safety, and almost all of the nursing diagnoses in that section are "risk for..." diagnoses. However, because NANDA-I has learned that nursing faculty is often responsible for this fallacy, the language on these has recently been revisited and was changed to include "Vulnerable to ..." in the defining characteristics the current edition.

 

 

Prioritizing your diagnoses: This sort of assignment is often made not only to see if somebody can recite rote information but to elicit your thought processes and see how well you can defend your reasoning.

 

 

So, you should be prepared to present the reasoning you have applied to your diagnoses and priority ranking. Why is one more important than another? There may be no one answer— just remember, you are supposed to be learning how to figure this out.

 

 

Working with a hypothetical patient: If there are only medical diagnoses given, you may have a little more work to do,. But you can also exercise your creativity more, by looking in your books and seeing what kind of symptoms of nursing diagnoses someone with those medical diagnoses may demonstrate. I can't tell you what they might be. You have to have some symptoms in mind, and then identify them in the lists of defining characteristics in the diagnoses you think might apply.

So let's look at yours. Remember, "related to" means "caused by," and nothing else.

1) There is no such nursing diagnosis as "risk for maternal injury," so that's out. There are a lot of risk for .... injury diagnoses, so see if your patient meets criteria for one of those.

 

2) There is no such nursing diagnosis as "Knowledge deficit" either. However, you might look at "Deficient knowledge."

Definition: Absence or deficiency of cognitive information about a specific topic

Defining characteristics: Inaccurate followthrugh of instruction; inaccurate performance on a test; inappropriate behavior (e.g., hysterical, hostile, agitated, apathetic); insufficient knowledge

Related (causative) factors: Alteration in cognitive functioning; alteration un memory; insufficient information; insufficient interest in learning; insufficient knowledge of resources; misinformation presented by others

 

Does your assessment of this patient make it possible to make this diagnosis?

 

 

 

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24 Posts; 1,104 Profile Views

Thank you both. The OBGYN nursing diagnosis (mama and baby) were difficult for me initially because we were not allowed to use the things that were normal happenstance which made it even more difficult when you have a healthy pair. Haha. And AliNajaCat I really appreciate the detail in which you broke things down. It helped me immensely.

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69 Posts; 1,250 Profile Views

"I have to figure out 3 antepartum* NANDA nursing diagnoses for this patient."

Sigh.... So it seems that some faculty are still flogging the dead NANDA NDx horse. What a waste of time! Nurses make diagnoses all the time... but the NANDA nomenclature is a huge distraction.

My heart goes out to you. Good Luck.

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1,035 Posts; 6,849 Profile Views

"I have to figure out 3 antepartum* NANDA nursing diagnoses for this patient."

Sigh.... So it seems that some faculty are still flogging the dead NANDA NDx horse. What a waste of time! Nurses make diagnoses all the time... but the NANDA nomenclature is a huge distraction.

My heart goes out to you. Good Luck.

I hear you, but in all fairness if you haven't bothered to see the current NANDA-I (2015-2017) and all you know about it is the pre-2011 versions, you are sadly misinformed. The thing has been streamlined, made much more intuitive and accessible, and there's a really good intro section written expressly for students who are at the very beginning of their journey to think like nurses. It is a teaching tool primarily, of course, although some of us who are testifying experts in our fields use it as a powerful backup to support our work for both plaintiff and defense. Look up "Daubert" for more on that.

As an analogy, think back to when you learned to drive with Mr. Bradley at the high school. How much of what you had to attend to is now second nature when you get on the road? But you had to practice a lot of those things when you were learning them before you could ever be automatic. So with making diagnoses; an experienced nurse doesn't have to write out "as evidenced by /caused by" when diagnosing any more than an experienced physician does.

Students aren't there yet. When faculty requires them to prove the bases for their diagnoses by using standardized language from a validated resource, they're showing them the bases for thinking like a nurse and making them practice them, so that one day they'll be able to pull out of the driveway and cruise down the highway.

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