Care plan, for a tired student nurse, HELP

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80 yr old female with PVD, and chronic renal insufficiency, and she is bradycardic, and one AKA she has poor communication skills. My nursing diagnosis is Health maintenance, ineffective r/t impaired physical mobility and poor communication skills AEB: disinterest in medical history and lack of ability to exercise, and does not participate in ADLs

is this a good nursing dx or should i change it....

I am having trouble with goals and interventions... HELP:banghead:

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Specializes in med/surg, telemetry, IV therapy, mgmt.

hi, lwhite1, and welcome to allnurses! :welcome:

is ineffective health maintenance r/t impaired physical mobility and poor communication skills aeb: disinterest in medical history and lack of ability to exercise, and does not participate in adls the only nursing diagnosis you have? it is classified as a safety need under maslow's hierarchy of needs. she should have physiological nursing needs--especially if she is a hospital or nursing home patient. i'm looking at that medical diagnosis of pvd and wondering why you haven't addressed anything in relation to that. why is this lady in the hospital?

this is also an improperly constructed nursing diagnosis. the description of the problem "ineffective health maintenance" is defined by nanda as the inability to identify, manage, and/or seek out help to maintain health. the keyword in this definition is "inability". inability means unable, incapable, powerless, incompetent, or no skill at. with ineffective health maintenance the patient may not know/understand why they are not able to follow the plan of care, may not care, or may not mentally or physically be able to. the bottom line reason, or etiology, for their inability to identify, manage, and/or seek out help to maintain health is what becomes the r/t part of the diagnostic statement. so you need to think back through what you learned about this patient. is the bottom line cause for her failure to follow the medical plan of care because of her impaired physical mobility? that just doesn't make sense to me.

what supports and proves the patient isn't maintaining her health is the evidence, or data, you collected and it becomes the aeb part of the diagnostic statement. if you want to talk about "lack of ability to exercise, and does not participate in adls" then you need to be working with nursing diagnoses of impaired physical mobility and self-care deficit (specify). this part of your nursing diagnostic statement is evidence (symptoms, defining characteristics that are proof that she isn't able (capable, has the power, is incompetent, or lacks the skill) to identify, manage, and/or seek out help to maintain her health. "disinterest in medical history" is ok although i don't see the great importance of it, but you know her better than i do. to me, not showing any interest or concern in knowing about her medications, information about the pvd disease process and what she should be doing to support good health practices for it are better indicators of evidence for this diagnosis. this is the guidance that nanda gives us for the symptoms (aeb items) you should be looking for and have to support this nursing diagnosis:

  • history of lack of health-seeking behaviors [misses appointments, doesn't take medication or perform treatments on a regular basis]
  • inability to take responsibility for meeting basic health practices [this would be blaming others/passing the buck]
  • lack of expressed interest in improving health behaviors [statements like: "it's not going to make any difference if i take my medicine or not."]
  • demonstrated lack of knowledge regarding basic health practices ["mama always taught us to (do some bizarre thing to cure a fever)"]
  • demonstrated lack of adaptive behaviors to environmental changes

here is a webpage that has the nanda information and some goals and nursing interventions (although they may not apply to this patient) for this diagnosis: [color=#3366ff]ineffective health maintenance.

this lady has pvd which generally means there is atherosclerosis going on. you need to read up on the pathophysiology of this disease. is she diabetic? does she have any skin changes (pallor, dependent rubor) or open skin areas on her lower extremities? edema? coolness of the extremities compared to the other body areas? diminished or absent pulses? bruits? pain or claudication? paresthesias in the legs? difficulty with ambulation? is she on anticoagulants? because of the altered vascular changes these patients are at a high risk for skin breakdown and infection of any wounds. there is a very specific nursing diagnosis that addresses this physiologic nursing problem: ineffective tissue perfusion, peripheral and it takes priority over ineffective health maintenance. here is a link to a web page about the ineffective tissue perfusion: [color=#3366ff]ineffective tissue perfusion specify type: renal, cerebral, cardiopulmonary, gastrointestinal, peripheral

you need to get your patient's symptoms listed out so you can determine your nursing diagnoses. then, you can start working on goals and interventions which are based on treating the patient's symptoms.

for information on writing a care plan, see this thread:

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