Critique this for me please all!

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Hello Please look over this and tell me what I am missing! thank you all!!!!!!!! I attached it as an attachment!!!!!!!!!

Nursing Diagnosis for alz's.doc

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It looks good to me. Only thing I would change is, to not use abbreviations when typing a formal care plan. Also, not sure about your teachers, but ours require an "as evidenced by" for any actual diagnosis, but not for risk fors. Hope that helps.

Richard

ps. "wondering" vs "wAndering" needs to be changed. I wonder often mentally, but I rarely wander off the street. (does that make sense?)

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

i'm assuming that this is a case study and that this is not relating to a real patient, is that correct?

the first thing i notice is that you have not incorporated all your signs and symptoms in developing nursing diagnoses.

also, the four nursing diagnoses that you have are not sequenced in the correct priority listing. they should be listed in priority as:

  1. disturbed sleep pattern r/t confusion between day and night (a physiological need)
  2. impaired verbal communication r/t expressive or receptive aphasia (a safety need)
  3. impaired memory r/t global cognitive deficits (a safety need)
  4. risk for trauma r/t ataxia and propensity for wandering (an anticipated problem) - anticipated problems are always sequenced below actual problems

also, the actual formulation of a nursing diagnostic statement follows the following format:

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

a problem i am seeing with your diagnostic statements is that you are not including etiologies as the related factors (r/t part of the statement). many of your r/t things are actually patient symptoms and actually belong to the aeb (as evidenced by) part of a diagnostic statement. the symptoms are what your interventions and goals address. the etiology relates back to the underlying reason the symptoms have occurred.

disturbed sleep pattern
r/t confusion between day and night (a physiological need)

confusion between night and day sounds very much like a symptom and not a underlying reason for why this is happening. the actual underlying reason is the alzheimer's, but you can't use a medical diagnosis, but you can say simply that the etiology is confusion or dementia. so, the diagnosis can then be written as
disturbed sleep pattern r/t confusion aeb inability to know the difference between day and night.

impaired verbal communication
r/t expressive or receptive aphasia

expressive and receptive aphasias are symptoms, not related factors for this diagnosis. the underlying cause of these symptoms would be physiological changes in the patient's brain tissue. so, the diagnosis should be rewritten something like this:
impaired verbal communication r/t physiological changes in the brain (secondary to alzheimer's disease) aeb expressive or receptive aphasia.

impaired memory
r/t global cognitive deficits

again, global cognitive deficits are symptoms and you should be more specific about what these deficits are. but the underlying cause is the same as for the impaired verbal communication.
impaired memory r/t physiological changes in the brain (secondary to alzheimer's disease) aeb [cognitive deficits]

risk for trauma
r/t ataxia and propensity for wandering

how are ataxia and wandering going to cause an injury? there has to be a link between an injury and your risk factors. i can see the ataxia leading to falling. but wandering in and of itself is not dangerous and will not lead to a direct cause of trauma. but something like slippery floors or an unsteady gait will.

now, what about all the other signs and symptoms that you didn't address? you have only one nursing diagnosis that addresses the patient's physiological needs, the most important needs, the ones he needs to survive. all the basic adls (activities of daily living) fall under these diagnoses. you listed difficulty walking and inability to accomplish adls in your list of signs and symptoms. these are two biggies! this is what nurses do--help patients accomplish their adls! as alzheimer's patients lose their cognitive abilities they also lose the ability to remember to perform bathing, dressing, eating, toileting, ambulation and the ability to communicate their needs. there's a whole battery of nursing diagnoses for these and this is where we nurses shine in taking care of these patients. you need to include some of these in this case study:

  • bathing/hygiene self-care deficit r/t cognitive impairment
  • dressing/grooming self-care deficit r/t cognitive impairment
  • feeding self-care deficit r/t cognitive impairment
  • imbalanced nutrition: less than body requirements r/t inability or refusal to ingest food
  • adult failure to thrive r/t impaired memory and judgment
  • toileting self-care deficit r/t cognitive impairment
  • functional urinary incontinence r/t impaired cognition
  • impaired physical mobility r/t severe neurological dysfunction
  • wandering r/t cognitive impairment

other nursing diagnoses you could be using based on the list of symptoms you have are:

  • disturbed thought processes r/t impaired neurological function (disturbances in behavior, personality changes, violent behavior)
  • chronic sorrow r/t chronic illness (depression)

i'm sure there's more i am missing. however, the adls are most important. and, this is your assignment and i've already given you a big helping hand. read the posts in these two threads on how to write a care plan and determine nursing diagnoses since that is basically what this assignment is:

here are some links to information on alzheimer's disease:

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