Daytonite

HeavenBound0530 · Sep 8, 2007

I didn't think you had to have 3 parts with a risk diagnosis...i thought they were only two part...and either way i don't see how oxygen is a risk for infection...but that's just me..there are alot of people on oxygen and I wouldn't think they are a risk for an infection...but again, I'm pretty sure a risk is only a 2 part thing, your nanda and your r/t...no manifestations...

EricJRN, MSN, RN · Sep 8, 2007

I didn't think you had to have 3 parts with a risk diagnosis...i thought they were only two part...

She's right. If you have evidence of something, it's an actual diagnosis instead of a risk dx. In other words, no 'as evidenced by' for a risk dx.

CapeCoralChick · Sep 8, 2007

DUH, OK I swear I knew that and wasn't thinking. Ok, that solves that one. What do you think about the ineffective airway clearence, or should I use risk for injury because of the Brittle Bone disease???

Thanks!!

LaceyRN · Sep 8, 2007

I am not daytonite but I would use the Ineffective Airway Clearance for 2 reasons. First, it is an actual diagnosis and not a risk for, and secondly because it takes priority using both Maslow's heirarchy of needs and following the ABC's (airway, breathing, circulation.)

Good Luck on your care plan!

CapeCoralChick · Sep 8, 2007

Thanks, yes I think airway is very important (ABC's). As well as the risk for infection. She has been in the hospital numerous times this year for infection. She was so premature at 24 weeks and has so much damage to her lungs.

I appreciate everyones help.

Do you think the ineffective airway clearance diagnosis is written well???

Eirene, ASN, RN · Sep 9, 2007

do you think the ineffective airway clearance diagnosis is written well???

i'm definitely not daytonite either, but i think it's written well!

you're on the right track! daytonite will be back soon, she's been very sick. please send her some healing vibes.

:flowersfo

CapeCoralChick · Sep 9, 2007

Thanks, I appreciate anyones help. It's nice to bounce ideas off each other. I just made this thread with her name because she is an excellent instructor. She helps everyone out and doesn't make you feel stupid. I admire her, and her time she put's into us nursing students!

I finished two of my three diagnosis today, I used the risk for infection and ineffective airway clearance. I spent alot of time on them but I don't like to turn in work just to get by. I was amazed to see how bad some of my fellow students careplans were, kinda sad!

Tara

Daytonite, BSN, RN · Sep 11, 2007

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:

problem (nursing diagnosis):

etiology (cause of the symptoms):

can't be an official medical diagnosis. don't be fooled when you see things like "chronic obstructive pulmonary disease (copd)" as a nanda approved related factor. nanda does not consider copd to be a medical disease. even medicare doesn't recognize this as a good medical diagnosis and will slap the doctor's hand and ask for a better definition of the medical condition! the same goes for anxiety.

symptoms (defining characteristics):

these are actual things the patient is experiencing and you find them through your assessment of the patient and review of their medical records

this is what you have written:

problem (nursing diagnosis):

ineffective airway clearance

etiology (cause of the symptoms):

chronic lung infections

symptoms (defining characteristics):

chronic lung disease, tracheitis, need for suctioning on a daily basis, tracheostomy, ventilator support, absent cough, abnormal breath sounds, and increased secretions.

question:

is "chronic lung disease" a symptom? if not, it doesn't belong here.

question:

is "tracheitis" a symptom? if not, it doesn't belong here.

thought:

"need for suctioning on a daily basis" is not specific enough information. how often/how many times an hour does the patient need to be suctioned? that is the kind of symptom you need to have for this kind of nursing diagnosis

question:

does the presence of a tracheostomy create a symptom for the patient or is it an etiology (underlying cause) of some of the symptoms that are creating an obstructed airway. shouldn't "presence of tracheostomy" be an etiology in the diagnostic statement?

question:

is "ventilator support" a symptom? is it an etiology? or, is it a medical treatment for a medical condition?

this is what would be better:

problem (nursing diagnosis):

ineffective airway clearance

etiology (cause of the symptoms):

presence of a tracheostomy and chronic lung infections

symptoms (defining characteristics):

needing to be suctioned three times an hour for thick tenacious mucous, absent cough, rhonchi throughout all lung fields, and production of 60 ml of sputum per day

as you see, i would get more specific with the last two symptoms of the abnormal breath sounds and increased secretions. the abnormal breath sounds can be described as wheezes, rales or rhonchi and where in the lung fields they are located. the increase in secretions is also measurable. how much more is being suctioned out today as opposed to yesterday or last week? has the color or consistency changed?

if you have a care plan book, you need to look at the care plan that has information about the nursing diagnosis of ineffective airway clearance. many of the recent books reprint the nanda information of the definition, defining characteristics and related factors that have been assigned to each nursing diagnosis. use these as a guideline in writing your nursing diagnostic statements so that they fit the form

nursing diagnosis--related factor (this is the etiology)--defining characteristics (these are your patient's symptoms)

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:

the writing of a care plan

always

starts with a thorough assessment of the patient--

always

,

always

,

always

.

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.

Music in My Heart · Sep 11, 2007

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.

best wishes to you daytonite.

CapeCoralChick · Sep 12, 2007

daytonite!! hi, thanks for getting back to me. i hope your doing ok. i want to thank you for taking the time to help me out, even when you're suffering side effects of some nasty stuff!! i go to peds oncology next week and i'm looking forward to the learning experience.

you surely come up with brilliant explanations. i hope to do the same for others one day.

first off, i agree and understand the assessment issues.

question: is "chronic lung disease" a symptom? if not, it doesn't belong here. no it's not a symptom, i understand my mistake

question: is "tracheitis" a symptom? if not, it doesn't belong here.again, not a symptom- ok i kind of feel silly now!

thought: "need for suctioning on a daily basis" is not specific enough information. how often/how many times an hour does the patient need to be suctioned? that is the kind of symptom you need to have for this kind of nursing diagnosis she does need to be suctioned at least twice an hour. i understand that i need to be much more specific.

question: does the presence of a tracheostomy create a symptom for the patient or is it an etiology (underlying cause) of some of the symptoms that are creating an obstructed airway. shouldn't "presence of tracheostomy" be an etiology in the diagnostic statement? i see where your coming from. it is not a symptom but a cause. i won't make this mistake again.

question: is "ventilator support" a symptom? is it an etiology? or, is it a medical treatment for a medical condition? again, not a symptom.

ok, from now on when i start a care plan i will make a list and then give greater detail regarding these symptoms.

now, i see where your coming from with the nutritional diagnosis. it is on the top of the priority list. i got all excited and already did risk for infection and ineffective airway clearance. i really don't want to do another diagnosis, i don't have the time. i will however explain to my instructor i understand the priorities. she is very nice and won't mind. as long as i learn in the process is the most important. i will however get some information together on her developmental issues and further address that this week. i will email you what i come up with. i hope after this lesson i actually get the diagnosis/statement correct.

i actually enjoy care plans. the more i learn the more i want to try again. i do have two more besides this due in the next month. i will also let you check out my improvements!!!

i love peds and spent the last two days in the picu. there are tons of clients that could use some good care plans. i will be at the picu again next week. follow up may be a bit easier too.

i will get everything together and email you. i really appreciate your help. i hope your chemo goes well. you are such a nice person, i only hope you receive good in return. if i can help you in any way please let me know. even if you just want to talk.

no rush to ever get back to me. i just kind of need a mentor/someone else that i can kick ideas around with.

take care!!!

tara

p.s i have a few care plan books

Daytonite, BSN, RN · Sep 12, 2007

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.