Bradycardia..need assistance with nursing diagnosis

Esme12, ASN, BSN, RN · May 28, 2012

i'm doing a paper on bradycardia i need 3 nursing diagnosis does anyone have any ideas

welcome to an! the largest online nursing community.

we are happy to help with homework but we won't do it for you. apart of the nursing process that is so important is to learn how to critically think. to know how to find information on how to care for your patient and know why you are taking the actions that you need to think.i would like to know what you have looked up so far. show me what yoiu have and wht kiond of paper and i will be happy to show you what youneed and how to get there. what semester are you?

first.......

you have to know your pathophysiology of the disease process and treatment. 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 them as a recipe to caring for your patient. your plan of how you are going to care for them.

what is bradycardia? is bradycardia ever "normal? what happened to a patient with bradycardia?

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. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is 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.

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:

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)
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)

what would you need to know about a patient with bradycardia? why does this patient have bradycardia? what type of paper is this?

Home Health Columnist / Guide · May 28, 2012

Hi. I moved you post to separate thread. Tell us more about your patient scenerio and ideas you have so we can help your thinking process.

Double-Helix, BSN, RN · May 28, 2012

You're making a very common mistake that students often make when writing care plans.

You DO NOT come up with nursing diagnoses based on the MEDICAL DIAGNOSIS. No, no no.

You DO come up with nursing diagnoses based on your ASSESSMENT of the patient.

There is asymptomatic bradycardia and symptomatic bradycardia. Is your patient having symptoms related to the slow heart rate? What are they? What are the vital signs? What's the capillary refill? What are the pulses like? How is the patient's neuro status? What is your head to toe physical assessment of the patient? What psycho-social issues have you identified? Why is the patient in the hospital in the first place? What is the patient unable to do for themselves?

You cannot write a care plan based on the diagnosis of bradycardia. You simply can't do it. You need to go in and do a thorough assessment of your patient and then come up with diagnoses that fit based on your assessment.

nurseprnRN, BSN, RN · May 28, 2012

^ hi ashley !

no, the medical diagnosis isn't the nursing diagnosis. there simply is no table somewhere that says, "medical diagnosis, column a; corresponding nursing diagnoses, column b." doesn't exist. but a medical diagnosis can be a defining characteristic; if you have looked in your nanda-i 2012-2014 you will see quite a few nursing diagnoses with one of the defining characteristics = "disease process." if you don't have that book, get it now from your favorite online bookseller or nanda-i itself.

this still does not mean that there is a magic list of medical diagnoses from which you can derive nursing diagnoses. nothing is farther from the truth.

yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.

for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology. i'm pretty sure i will probably see a constellation of nursing diagnoses related to these effects, and i will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. i might find readiness to improve health status, or ineffective coping, or risk for falls, too. these are all things you often see in diabetics who come in with complications. they are all things that nursing treats independently of medicine, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. but i can't put them in any individual's plan for nursing care until *i* assess for the symptoms that indicate them, the defining characteristics of each.

medical diagnoses are derived from medical assessments-- diagnostic imaging, laboratory studies, pathology analyses, and the like. this is not to say that nursing diagnosis doesn't use the same information, so read on.

nursing diagnoses are derived from nursing assessments, not medical ones. so to make a nursing diagnosis, a nursing assessment has to occur. for that, well, you need to either examine the patient yourself, or (if you're planning care ahead of time before you've seen the patient) find out about the usual presentation and usual nursing care for a given patient.

medical diagnoses, when accurate, can be supporting documentation for a nursing diagnosis, for example, "activity intolerance related to (because the patient has) congestive heart failure/duchenne's muscular dystrophy/chronic pulmonary insufficiency/amputation with leg prosthesis." however, your faculty will then ask you how you know. this is the dread (and often misunderstood) "as evidenced by."

in the case of activity intolerance, how have you been able to make that diagnosis? you will likely have observed something like, "chest pain during physical activity/inability to walk >25 feet due to fatigue/inability to complete am care without frequent rest periods/shortness of breath at rest with desaturation to spo2 85% with turning in bed."

so, you don't think of a diagnosis for your patient and then go searching for supporting data. you collect data and then figure out a nursing diagnosis.

yes, this is harder than you thought. you're in college to learn a profession, and it's like nothing you have ever done before! i hope this is helpful to you who are just starting out in this wonderful profession. it's got a great body of knowledge waiting out there to help you do well for and by your patients, and you do need to understand its processes.

Nurse Kyles, BSN, RN · Jun 1, 2012

The above posters are all very helpful! They really help you with the thought process. The nursing diagnosis book that my school used was "Nursing Diagnosis Handbook" by Betty Ackley (8th Edition). This book is set up that in the front section of the book had medical diagnosis listed alphabetically. Each medical diagnosis had applicable nursing diagnosis underneath. You then look up the nursing diagnosis in the second session & see which nursing diagnoses are applicable to your patient. There will be a list of "defining characteristics" Compare your assessment data to these defining characteristics. Then decide if this diagnosis suits your patient. This kind of feeds into deriving nursing diagnoses from medical diagnosis which is clearly stated above as a no-no. I do think that using this book with the medical/nursing diagnosis listed in an appendix helps you a long with your thought process. Kind of like training wheels. You will one day be able to think of assessment data & pathophys & know what nursing diagnosis suits your patient. At the beginning it is very hard to start from scratch, especially if maybe you are a 1st semester student who might not even have a pathophys class under your belt yet. Just remember when looking up nursing diagnoses to make sure it is applicable to your patient, and that interventions are suitable for your patient as well.

MattNurse, MSN, RN · Jun 1, 2012

You are doing a paper on bradycardia and do not have a patient if I understand you correctly:

Decreased Cardiac output

Ineffective Health maintenance

Ineffective Tissue perfusion

Risk for Injury

Risk for Poisoning

Esme12, ASN, BSN, RN · Jun 1, 2012

Matt Nurse gave you plenty of suggestions for nursing diagnosis....Matt Nurse is being very good to you.

I always prefer for you to show your work first and what you thought process is first so I know best how to help you become the best nurse you can be. Just giving you the answer, IMHO, will not help you develop those all important critical thinking skills. Learning how to problem solve and where to go to research your own answers is a vital skill in becoming the best nurse you can be.

We will help you....extensively if you let us know what you have so far. Peace :paw:

CT Pixie, BSN, RN · Jun 1, 2012

You are doing a paper on bradycardia and do not have a patient if I understand you correctly:
Decreased Cardiac output
Ineffective Health maintenance
Ineffective Tissue perfusion
Risk for Injury
Risk for Poisoning

I'm tired, so maybe my neurons aren't firing correctly..but how is Risk for Poisioning a NANDA for bradycardia?

MattNurse, MSN, RN · Jun 1, 2012

I'm tired, so maybe my neurons aren't firing correctly..but how is Risk for Poisioning a NANDA for bradycardia?

Cardiac drugs like digoxin and beta blockers among others if taken improperly can cause bradycardia. You have a risk of poisoning if you don't know how to take your meds properly. And if you have bradycardia from being poisoned no "risk for".

Esme12, ASN, BSN, RN · Jun 1, 2012

I did a double take at first as well... :lol2: . Great suggestion MattNurse.

CT Pixie, BSN, RN · Jun 1, 2012

I did a double take at first as well.... Great suggestion MattNurse.

Ohh ok, yes. I wasn't thinking of cardiac meds. Since the OP didn't give any subjective/objective data (with the meds and the cause of the brady) I wasn't thinking of the pt being on cardiac meds as not all bradycardia requires at home cardiac medication depending on the cause of the condition.

But Matt is correct if the pt is sent home with new cardiac meds and/or has been on at home cardiac meds, then yes, Risk for Poisioning is a great one.