Care plans

I know what you are talking about.

Personally, I don't like using Noncompliance as a diagnosis. I always tell students to read the definition of the diagnosis before using it and also look at the related factors (causes) and defining characteristics to help clarify it all for you. Ineffective Health Maintenance is the alternative diagnosis I use for noncompliance. For safety problems you can use Ineffective Therapeutic Regimen Management if the patient is not following their plan of care because of finances, family or social problems or Impaired Home Maintenance can be used in some instances when you are doing home care and have specific data on what is going on inside the home to interfere with carrying out the plan of care.

If one of your fellow students has a care plan book that has a page or appendix that sorts the nursing diagnoses into Maslow's Hierarchy or Gordon's 11 Functional Health Patterns you might want to take a look at them.

Good luck on your exam.

I was just answering another student's question about a psych patient and noticed that my book had a chapter on the noncompliant patient. In psych patients, the nursing diagnoses it lists for mood, anxiety, and personality disorders and Alzheimer's and dementia where the patient is noncompliant are

• Noncompliance
  
• Anxiety
  
• Ineffective Coping
  
• Compromised Family Coping
  
• Deficient Knowledge
  
• Powerlessness
  
• Self-Care Deficit
  

It states: Nurse's willingness to examine their attitudes and feelings is of primary importance in dealing with noncompliant patients (page 119, Psychiatric Principles and Applications for General Patient Care). Nursing Strategies to Stop This Cycle: (for nurses) become aware of your feelings, perform a nursing assessment, use care planning as a mutual process (page 120).

Everything that I have read on noncompliance is that caution needs to be exercised that we, the caregivers, do not inject our own emotion into the situation because it only makes it all worse. A trusting relationship cannot be developed with the patient if the caregiver is unable to deal with their own anger over what the patient is doing.

make sure you understand what goes on in each step of the nursing process. the nursing process is a problem solving tool.

if you are given a scenario, do what i do when i answer questions here on the forums, go through it word for word and pull out each piece of data and make a list. from that list are your symptoms that go with the nursing diagnoses. diagnose. then develop your nursing interventions based on that list of symptoms. make sure your goals match up with the interventions you wrote.

there are certain nursing diagnoses that get used more than any others. they are the ones that ackley/lagwig and gulanick/myers decided to use on their care plan constructors. its a good idea to be familiar with their definitions, related factors and defining characteristics. here are the lists:

• http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
  

go over any notes your instructors gave you about the classification of the nursing diagnoses.

The physician is in charge of the care of the patient; we nurses are managing the care. We can request an order, and it is up to the doctor to approve or deny it. You often need a physician's order for these consults. The reason is very simply because the patient's insurance will not pay for them unless the order for these professional services has been generated by a physician. They are also collaborative services being given by licensed personnel in another healthcare discipline and they require an order to treat. So, we write something like "Contact MD for physical therapy consult" or "Ask MD for a physical therapy consult." Medicare and most insurance will not pay for PT services without an order from the physician. The PT departments know this and will not treat a patient without physician's orders for their services. Realities of being in business.

glad to hear you passed your test.

the case scenario sounded like constipation to me also. pain is a physiological need and classifies as comfort on the maslow hierarchy. you have to ask your instructor why they say the pain is a priority over elimination. they are using some other system to prioritize. that's ok, just that you need to know what it is for tests and assignments so you classify it the way they want so you don't lose points in the grading.

here's maslow's physiological needs by priority (comfort is at the bottom of the list):

1. physiological needs (in the following order)
   
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort
     

the order of the physiological needs are determined by what kills you the fastest.