is this a correct nsg dx

SolaireSolstice, BSN, RN · Dec 8, 2009

You don't do as manifested by AND as evidenced by. As manifested or as evidenced by both are the signs and symptoms (or defining characteristics of the nursing diagnosis) that you show to prove the nursing diagnosis, and can be used pretty much interchangably, though I've had instructors that tell me to use one or the other with no real explanation as to why. Generally I use as manifested by for the S&S of the nx diagnosis and as evidenced by on my goal. Altered preload could be the related to but you don't SEE the altered preload. Your patients S&S is only the edema? In absence of other S&S I'd go with Excess fluid volume.

Look up Daytonite's posts for her explanation on how to form a nursing diagnosis. She explains the process better that I could.

Daytonite, BSN, RN · Dec 8, 2009

i would word it:

decreased cardiac output r/t altered preload due to intropic changes aeb edema.

altered preload is the etiology of the problem and not evidence or manifestation of it. if you did not know this you need to read more about heart failure as well as look at the taxonomy for the diagnosis of decreased cardiac output which clearly lists altered preload as a related factor.

http://cvphysiology.com/index.html - cardiovascular physiology concepts, click on "heart failure" link at the left side of the page

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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.

thereisalight · Feb 9, 2010

I also have a few questions. My scenerio is a lady who complains of chest pressure but no pain. Her husband states that she has been SOB X3 days, trouble sleeping and slept in the recliner the night before. She now has edema in her feet. She has a hx of HTN and CAD. She takes Toprol, Lasix, Benicar, and K+ but hasnt in the past week due to not refilling the script. Pt states she is 162 lbs but when weighed was 175. Vitals are 198/102, 120, 34; pulse oximetry reading on room air: 79%. There are crackles in the lower lobes of lungs and moist sound with nonproductive cough. She is placed on 4L NC and CXR shows pulmonary congestion and cardiomyopathy.

So for for my nursing diagnosis I have:

Impaired gas exchange r/t pulmonary congestion aeb SOB and crackles upon ausciltation.

Ineffective health maintenance r/t pt not refilling medication for a week aeb pt now is having increase in blood pressure, SOB and edema.

I wanted to do another one on Excess fluid volume but I'm not sure if I'm even in the right direction. I could use a little help please!

bambam1288 · Feb 10, 2010

Excessive fluid volume r/t pulmonary edema AEB crackles ... I not sure because I don't have my book with me. This web site might help

http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH7e/Constructor/careplan_031.php

Daytonite, BSN, RN · Feb 10, 2010

A patient with CAD has Decreased Cardiac Output and that covers all the sypmtoms of edema and fluid retention because of the poor function of the heart.

thereisalight · Feb 10, 2010

Thank you so much! After reading some of your post I thought I should change it to Decreased Cardiac Output but I was hoping Id hear back from you to make sure!