diaper dermatitis

pinkiepie_RN · Oct 1, 2008

hello nurses. This all about making ncps but my problem is i cant state the nursing diagnosis correctly. Correct me if im wrong
An infant is having a diaper dermatitis.
Problem:Impaired skin integrity
Diagnosis: Impaired skin intergrityrelated to infectious lesions, possibly evidenced by disruption of skin surfaces
candidiasis and diaper rash the same? because i got the nursing diagnosis from candidiasis case.

http://www.medicinenet.com/diaper_rash/article.htm

Diaper rash appears to be a broad term encompassing skin irritation in the diaper area. It could be a form of contact dermatitis, candidiasis or something else altogether. That said, I think your ND sounds pretty good. Just use that data that you have (disruption of skin surfaces) and build on it. What do these lesions look like?

Daytonite, BSN, RN · Oct 1, 2008

the construction of the 3-part nursing diagnosis follows the following sequence of structure:

p - e - s

and is put together grammatically by adding these words

p related to e as evidenced by s

these three letters mean the following:

p (problem) - this is the nursing diagnosis. the words you use in writing the nursing diagnosis have already been determined for you by nanda-i, the north american nursing diagnosis association, international. you merely need to look them up in the most recent copy of one of their publications such as nanda-i nursing diagnoses: definitions & classification 2007-2008 or in any of the many currently printed nursing care plan or nursing diagnose reference books that are in publication containing this information. a nursing diagnosis is only a shortened label of the nursing problem which is more broadly defined and explained for you in the definition of each nursing diagnosis contained in these references.
e (etiology) - an etiology is the origin of the cause of this identified nursing problem (p). it cannot be stated as a medical diagnosis. in publications like the nanda taxonomy (nanda-i nursing diagnoses: definitions & classification 2007-2008) you will find etiologies listed for many of the nursing diagnoses under the heading of "related factors". for physiological nursing problems (nursing diagnoses) you will need to know the pathophysiology of the disease process in order to determine the correct etiology, or related factor.
s (symptoms) - symptoms are the manifestations of the identified nursing problem (p). symptoms are determined by performing a thorough assessment of the patient and finding what is abnormal. symptoms are abnormal findings. in the nanda taxonomy you will also find symptoms listed for many of the nursing diagnoses under the headings of "defining characteristics". symptoms are proof that the problem exists. you will not have symptoms for "risk for" diagnoses because these are not actual problems, but anticipated problems.

let's look at your patient situation. . .an infant with diaper dermatitis (a medical diagnosis). i am always saying that when you sit down to write a care plan, follow the steps of the nursing process in the sequence that they occur--take the time to do this.

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - your burning question which you should answer before going any further, and that includes formulating your nursing diagnostic statement is "what is diaper dermatitis?" that falls under the heading of assessment because it is investigation of the facts of the case. as you gain experience in nursing these fact-finding forays into textbooks and on the internet for this kind of information will lessen as your knowledge about them grows. for now, you have to go looking. you need to know what diaper dermatitis is and what causes it.

http://kidshealth.org/parent/newborn/basics/diaper_rash.html - diaper rash
http://familydoctor.org/online/famdocen/home/children/parents/infants/051.html - diaper rash
http://www.merck.com/mmpe/sec10/ch120/ch120b.html - candidiasis

from that reading i get that the cause is moisture. while a yeast infection (candidiasis) can occur it is a complication. the moisture and warmth have to be there first. this is a biological principle that explains how life is sustained. however, you are looking to identify a problem--skin breakdown. keep focused. i wouldn't use "infectious lesions" because this is a medical decision (medical diagnosis) and it also sends a picture in my mind of pus emanating from them. is that really happening here?

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - you list your data as: "disruption of skin surfaces". disruption of skin surfaces sounds like a generic symptom that came out of the taxonomy. you have to individualize this more to the patient. what does this rash looks like? what was written in the chart? look at how the articles referenced above detailed these rashes. you need to do the same.

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - you already know this part. . .impaired skin integrity (impaired skin integrity and http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=48)

you suggested:

problem: impaired skin integrity

diagnosis: impaired skin integrity related to infectious lesions, possibly evidenced by disruption of skin surfaces

note:

don't use the word "possibly" with "evidenced by". you either have evidence or you don't. evidence is fact supporting the problem. without evidence you have no problem.

this would be better:

impaired skin integrity related to warmth, moisture and mechanical irritation as evidenced by [your description of the rash]

teeniebert, LPN · Oct 3, 2008