Care Plan Diagnosis Help!!

[treblig4595]

Okay, So i am making my first care plan, and I am having issues with my nursing diagnosis creation and prioritization. A Hx of my pt.....

78 y/o female with a primary dx of seizures (but they only happen occasionally, as in once/year), COPD, Primary HTN, and Mild Dementia. Her only real issues are that she has marked weakness in her Rt arm and hand with +1 nonpitting edema and slight redness only in that extremity. Her legs are weak and she transfers with 2 assist to a w/c, where she sits all day until she goes to bed. She cannot provide ADLs for herself, including brushing teeth, applying dentures, brushing hair, feeding, getting to and from the BR, or cleaning self after toileting. She wears glasses. She is occasionally urge incontinent in the am when she wakes because staff "cannot get there fast enough". Her right arm is only painful when she abducts it, but otherwise has no other pain. She does occasionally experience orthostatic hypotension. She is a past smoker, with a hx of COPD but currently has no breathing issues.

I am having a hard time formulating nursing DX for this patient....and prioritizing these dx...

The Dx i have so far are as follows

-Impaired Physical Mobility

-Self-Care Deficit: Toileting

-Urge Urinary Incontinence

-Self-Care Deficit: Feeding

-Risk for Impaired skin integrity

Any help would be appreciated!!!

[Kuriin, BSN, RN]

I feel like you need to relook at your patient's history and think of some things that may take precedence over things you currently have (eg: toileting).

[treblig4595]

If you're referring to her COPD, HTN, and dementia, she has no issues with breathing, not even on exertion and her lung sounds are clear bilaterally A&P, in regards to her HTN, she is taking an antihypertensive for that (why she probably gets orthostatic hypotension), and her dementia is so mild that it does not affect her daily life. She just doesn't have a lot wrong with her....thank you for for help!

[AliNajaCat]

Orthostatic hypotension is a risk factor for ... Yes, risk-for diagnoses are actual and real. How would you protect her from ... ?

I don't fault students for going for the low-hanging fruit, because you don't know much yet and I'll bet somebody told you you have to "pick" nursing diagnoses, rather than teach you that you are in nursing school to learn to MAKE nursing diagnoses and plan/delegate care accordingly. You get to choose and defend your priorities for her based on what can kill her or injure her or otherwise harm her first or more seriously, and then work down from there. Take a wider view.

You should thumb through your NANDA-I 2015-2017 (GET IT NOW) to see if you can make other nursing diagnoses based on a more thoughtful assessment. How's her home safety? Are there plans for what happens to her when her dementia advances? Does she have family involvement? What are their wishes? How is her ability to seek care and follow directions? Who shops and cooks for her?

[AliNajaCat]

bumping for the new semester :)