Daytonite

i have been offline for 4 days and haven't even looked at what has been posted on allnurses.

i read your questions. first of all, what is your assessment information? i got all the medical information. that's great, but it's not enough. any nursing diagnoses you choose are always based upon the abnormal assessment information that you obtain. although the patient's underlying medical diagnoses and medical problems can help you look at likely nursing diagnoses that might apply, it is always the patient's symptoms which you found during your assessment activities that ultimately determine what nursing diagnoses you use.

i wanted to address the psychosocial nursing diagnosis first since you seemed to be at a loss regarding it. you have a one-year old child here. you need to do a psychosocial assessment for a one year old child to see if she is meeting the parameters expected at one year of age. here is a webpage that lists the skills a 12-month old should be able to perform: http://www.baptistonline.org/health/library/chil3055.asp. while you are doing peds, you might want to bookmark this site for a quick reference. you should also consult a growth and development textbook for specific psychosocial skills to see how this child compares and where she may have lags in her development. as a child who has been ill much of her life i think i am pretty safe in saying that she is bound to have developmental and social delays. you need to identify them and these symptoms then need to be matched against nursing diagnoses. there are two diagnoses related to developmental delays (these are self-actualization needs) and you can include your pyschosocial problems with them: risk for delayed development and delayed growth and development. there may be other psychosocial diagnoses related to social interaction or attachment that you might want to use. i urge you to look at the nanda related factors and defining characteristics under any of these diagnoses before assigning them to the patient to make sure they fit with your patient.

as for: ineffective airway clearance r/t chronic lung infections as manifested by: chronic lung disease, tracheitis, need for suctioning on a daily basis, tracheostomy, ventilator support, absent cough, abnormal breath sounds, and increased secretions. i would like to address the construction of the diagnostic statement with you.

nanda has more recently been saying that they reflect nursing terminology (as opposed to medical terminology), so the wording of nursing diagnostic statements is important. and, we wonder why schools insist english is always a required class! what nanda has printed in nanda-i nursing diagnoses: definitions & classification 2007-2008 has been reprinted in care plan and nursing diagnoses books currently published and should be considered nursing terminology that is acceptable to use. people sit around conference tables at nanda trying to come up with the best ways to word some of these diagnoses and related factors so we don't have to sit scratching our heads trying to figure it out ourselves. a nursing diagnostic statement reflects 3 things:

this is what you have written:

this is what would be better:

or go to this web page: [color=#3366ff]ineffective airway clearance

now, what are you doing about addressing this child's problem of failure to thrive? granted this is a medical condition, but during your nursing assessment you should have picked up some symptoms related to this. you need to find information on infant failure to thrive and assess your little patient against this. look at the child's weight and diet. i think a nutritional nursing diagnosis of some sort is in order here. you have a gastrostomy tube that needs care as well. [color=#3366ff]imbalanced nutrition: less than body requirements

that covers two very basic physiological needs we all have for oxygen and food. so, let's look at maslow. how is this child doing with elimination, body temperature, the ability to move, sleep and comfort? assess for those and see if there are any problems there. these all take precedence before safety and psychosocial needs.

after all that, then, if you want to pull in a risk for infection r/t chronic inflammatory lung disease, although it sounds a little redundant to me because of the chronic lung infections that you are using as a related factor with the ineffective airway clearance diagnosis, and

risk for injury r/t ??? secondary to oi (see the related factors for this diagnosis at [color=#3366ff]risk for injury), you can.

that should give you some direction in which to go. i always threaten to have this tattooed somewhere on my body:

you will knock yourself out trying to find more and more ways to get the most thorough assessment data you can find. without that abnormal data (symptoms) it is hard for me to give much specific help. without that abnormal assessment data, you only think you have a care plan. most of the time you inherently know the abnormal data but have failed to physically write it on a piece of paper. but, the instructor who grades your care plan is going to be looking for it. it does no good hanging around in your mind. it has to be written on your paper. if they don't find it on the paper you hand in, they are going to be scratching their head just like me trying to figure out how you are making connections between the patient's nursing diagnosis, the symptoms you did provide on the paper and the nursing interventions. there is a very logical and rational flow to the way all this information is put together in a care plan and your instructors are going to be looking for how you accomplish that. they can't read your mind.

redo your assessment and list of abnormal assessment items for this patient. do a little editing and repost an amended list of nursing diagnoses for me to look at. i'm getting another dose of chemotherapy on wednesday, thursday and friday and i'm calling next week hell week because of the resulting symptoms, but i'll be at the computer to answer questions.

your instructor sounds like a wonderful person. as long as you are learning from the errors you make, that is all that is necessary.

take a look at the first pages of those care plan books that talk about the nursing process and how to write a care plan. it takes a little time to read and digest the information in them, but it is usually only a few pages. while the actual "nursing terminology" does get changed a bit from year to year by nanda, the concept of the nursing process and the steps that go into writing a care plan do not. that pes formula (problem-etiology-symptom) for writing the nursing diagnostic statement has been a staple of nursing diagnosis and care plans for years! the five steps of the nursing process (assessment, determining the problem(s), planning, implementation and evaluation) also remains the same. it is an extrapolation of the scientific process.