Diff btwn Self care deficit and Ineffective Hlth Maint.

CT Pixie, BSN, RN · Mar 23, 2012

So is my ns dx Ineffective health care maintenance or is it Self Care Deficit? Or both? And can these trump and more physiological Dx such as Decreased cardiac output? Our care plans only have to have 2 ns dx and they are certainly supposed to be in order of importance, but this guy is low income, low education level and I am worried that his overall issues and lack of compliance are going to cause more problems than his heart issue. Or, am I supposed to put aside what I THINK he is going to do, and believe him when he says he will eat what's on his "menu"? By the way, he eats eggs for breakfast - every morning - and that's not going to change. He said he will eat what we tell him to for Lunch and Dinner.

During my schooling for LPN and now during my LPN to RN bridge, we had to put the in priority order..and ABC always trumped self care deficit or health care maintenance. He's in the hospital for CABG, his edema is due to his heart issues, he's on continuous O2 and his K+ is way too high! His heart condition certainly take priority over his health care maintenance and/or his self care deficit.

While you could use one of the two you mentioned, if I were you, I'd be sure to put a cardiac related on that care plan. However, I would go with Imbalanced nutrition, more than body requirements (he's eating too much and too much of the wrong foods, which you can use for both the cardiac AND IDDM dx) over the care deficit. You left out some info, but I'd have to assume he's got some pain which is r/t the CABG, that trumps the two you want to use. Basically, if it were my care plan..the two you want to use would be pretty far down my list.

If you say your care plans are "certainly supposed to be in order of importance", I'd say, you already know your answer..don't put one or the other as a priority over cardiac.

You could incorporate Ineffective Health Care Maintenance with the cardiac AND IDDM dx because the r/t factors are deficient knowledge regarding postprocedural care (his CABG), lifestyle adjustment after surgery (r/t both his CABG and his IDDM). the lifestyle adjustments would include changing his diet..not only does his bad food choices affect his DM, it for sure affects his heart and arteries.

Hope that makes some sense.

Esme12, ASN, BSN, RN · Mar 23, 2012

I look and them as one is habit/lifestyle/social economic and the other "disease" like stroke. I agree that the CABG is first as it is the most pressing and present but the other will need to be solved/cared for before he goes home. But don't forget how hard it is to be poor and on a fixed income. Many have to choose between medicine and eating/warmth/rent.....healthy organic food is expensive. They are too proud/embarrassed to admit it and want to remain fiercely independent. It's great to point it out but realistically difficult to change.

Ineffective Health Maintenance

NANDA-I Definition: Inability to identify, manage, and/or seek help to maintain health

Ineffective health maintenance reflects a change in an individual's ability to perform the functions necessary to maintain health or wellness. That individual may already manifest symptoms of existing or impending physical ailment or display behaviors that are strongly or certainly linked to disease. The nurse's role is to identify factors that contribute to an individual's inability to maintain healthy behavior and implement measures that will result in improved health maintenance activities. The nurse may encounter these patients either in the hospital or in the community; the increased presence of the nurse in the community and home health settings improves the ability to assess patients in their own environment. Patients most likely to experience more than transient alterations in their ability to maintain their health are those whose age or infirmity (either physical or emotional) absorb much of their resources or those for whom the economic challenges of daily life negate an interest in personal health. The task before the nurse is to identify measures that will be successful in empowering patients to maintain their own health within the limits of their ability.

Common Related Factors

Perceptual/cognitive impairment

Presence of physical disabilities or challenges

Presence of adverse personal habits:

Smoking
Poor diet selection
Morbid obesity
Alcohol abuse
Drug abuse
Poor hygiene
Lack of exercise

Low income/lack of material resources

Lack of access to care

Lack of knowledge

Poor housing conditions

Ineffective coping

Risk-taking behaviors

Inability to communicate needs adequately (e.g., deafness, speech impediment)

Dramatic change in health status

Lack of support systems

Denial of need to change current habits

Self-Care Deficit

NANDA-I Definition: Impaired ability to perform or complete activities of daily living for oneself, such as feeding, dressing, bathing, toileting

. The deficit may be the result of transient limitations, such as those one might experience while recuperating from surgery, or the result of progressive deterioration that erodes the individual's ability or willingness to perform the activities required to care for himself or herself. Careful examination of the patient's deficit is required in order to be certain that the patient is not failing at self-care because of a lack of material resources or a problem with arranging the environment to suit the patient's physical limitations. The nurse coordinates services to maximize the independence of the patient and to ensure that the environment the patient lives in is safe and supportive of his or her special needs. This care plan combines a variety of self-care deficits into one comprehensive plan.

Common Related Factors

Neuromuscular impairment

Musculoskeletal impairment

Impaired mobility or transfer ability

Cognitive impairment

Perceptual impairment

Fatigue, weakness

Pain

Severe anxiety

Decreased motivation

Environmental barriers

Defining Characteristics

Inability to feed self independently

Inability to dress self independently

Inability to bathe and groom self independently

Inability to perform toileting tasks independently

Inability to transfer from bed to wheelchair

Inability to ambulate independently

Inability to perform miscellaneous common tasks such as telephoning and writing

Gulanick: Nursing Care Plans, 7th Edition

Kef89 · Mar 23, 2012

Thanks a bunch! I appreciate both of your perspectives!

nurseprnRN, BSN, RN · Mar 26, 2012

as for people who can't reach to clean themselves after bms, there's an app for that. well, no, not an app, but there are some nifty gadgets made for use by people with mobility or dexterity issues. honest. do the poor guy a favor and get him one. disclaimer: no financial interest in this product.

personal hygiene wand: home | freedom wand

the freedomwand® is a multi-task, multi-length tool; it holds an ointment pad, loofah or lightweight wash cloth, disposable shaver and the all-important toilet tissue. the freedomwand can be used from 7-30" and comes with a cloth carry bag. it’s specifically designed for personal cleaning and hygiene for anyone with limited mobility. the easy to use slide button releases tissue into the toilet with little effort. the freedomwand® is made from a polypropylene material, making it very durable and easy to clean. it is also designed with a rinse hole in the head to aid in easy cleaning.

Kef89 · Mar 29, 2012

Thanks GrnTea - I haven't looked at your link yet, b/c i'm afraid i'll get off track (trying to study). But i will, and i thank you in advance!

:-)