CarePlan - Starting with Nursing DX

CT Pixie, BSN, RN · Feb 2, 2010

Its been about 2yrs since I've had to do a care plan for school but..

Ineffective Individual Coping R/T depression AEB Verbal report of grief SECONDARY TO congenital birth defects of child

a person verbalizing grief doesn't necessarily mean they are ineffective with coping. Grieving is a normal process...but it doesn't in and of itself mean the person isn't coping nor does grieving signify depression.

Better wording might be Ineffective Individual coping R/T congenital birth defects of child AEB_______(give the evidence of ineffective coping..examples of what the person is doing/saying or not doing/saying to show they aren't coping)

chutley76 · Feb 2, 2010

Hmm . . so would this be better?

Nursing Diagnosis: Ineffective Individual Coping R/T congenital birth defects of child having a cleft palate

AEB Verbal report of grief and demonstrating withdrawn behavior

Daytonite, BSN, RN · Feb 2, 2010

first of all, ineffective individual coping is not an official nanda diagnosis. if your instructor gave you this diagnosis, ask for a definition to look at it so you know exactly what you are dealing with. the closest i would assume this definition comes to is with the diagnosis of ineffective coping whose definition is inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources (page 254, nanda international nursing diagnoses: definitions and classifications 2009-2011). related factors (causes) of this problem are threats, uncertainty and crisis situations. depression does not qualify as a cause for the coping because it is a medical diagnosis and cannot be used in a nursing diagnostic statement, but it can be broken down into its symptoms and those can be used as aeb items in this case.

fear or a threat that an unborn child might have congenital birth defects would qualify as a related factor, however. so, your diagnostic statement would be worded ineffective coping r/t fear of unborn child having congenital birth defects aeb [symptoms of depression and verbal report of ???]

grief means loss has occurred. if a person is having grief for some reason, there is a nursing diagnosis that covers that: grieving - definition: a normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families , and communities incorporate an actual, anticipated, or perceived loss into their daily lives (page 263, nanda international nursing diagnoses: definitions and classifications 2009-2011)

you are having problems with the construction of the 3-part nursing diagnostic statement. the construction of the 3-part diagnostic statement follows this format:

p (problem) - e (etiology) - s (symptoms)

problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
etiology - also called the related factor by nanda. this is what is causing the problem. it is the reason the problem exists and reasons can be many and varied. ask yourself "why did this happen?" or "how did this problem come about?" "what caused this to become a problem in the first place?" and dig deep. consider the medical diagnosis, the medical treatments that were ordered and the patient's ability to perform their adls. pathophysiologies need to be examined to find these etiologies if they are of a physiologic origin. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this.
symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

chutley76 · Feb 2, 2010

Thank you. Unfortunately yes, that is the DX I was assigned. That may be why I am having so many issues. This is supposed to relate to a post patrum mother. I am going to go with this:

Nursing Diagnosis: Ineffective Individual Coping R/T congenital birth defects of child having a cleft palate

AEB withdrawn behavior and verbilization of sadness.

Do you think this would be acceptable?

Daytonite, BSN, RN · Feb 2, 2010

thank you. unfortunately yes, that is the dx i was assigned. that may be why i am having so many issues. this is supposed to relate to a post patrum mother. i am going to go with this:
nursing diagnosis: ineffective individual coping r/t congenital birth defects of child having a cleft palate
aeb withdrawn behavior and verbilization of sadness.
do you think this would be acceptable?

no. your related factor has to convey that there is fear or threat. that is the cause of the person's inability to respond (cope) with the congenital birth defects of a cleft palate, not the congenital birth defects of child having a cleft palate itself. otherwise, the rest of the diagnostic statement is ok.

all the coping diagnoses (there are a number of them) have similar definitions and have to do with threat and fear as the related factors. please read the information i posted for you again.

Daytonite, BSN, RN · Feb 2, 2010

Something else I want to point out to you. Coping is a behavior. Ineffective Individual Coping would be a psychosocial, or behavior diagnosis. Therefore, any related factor would need to be associated with behavior. Congenital birth defects of a cleft palate is a physical problem and not a behavioral problem so it would not fit as a related factor or cause of any coping problems. It is the behavior that it causes to bring about the Ineffective Individual Coping that you would be looking for as the related factor, or cause in your diagnostic statement. Since threat, fear or a situational crisis are what bring about problems with coping that is what you would be looking for. It is the fear or threat of a baby having a congenital birth defect of a cleft palate that sets off the Ineffective Individual Coping problem when the person develops symptoms of depression or begins to talk about their fears or worries about their unborn baby having these potential problems.