Err...hope I got this diagnosis stuff right!! Pls. Help!

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Okay. I do not have a real pt yet, as we have not actually gone to clinicals yet. We were given two medical diagnosis. One is obesity and my other is hypertension. I have been most of the afternoon working on my obesity one, so let me know what you think!

Medical Diagnosis: Obesity

Nursing Diagnosis: Risk for Impaired skin integrity related to decreased mobility as evidenced by skin breakdown on back and thighs.

Intervention/ rationale:

  • ]Intervention: Keep skin dry and clean. Rationale: Moisture leads to skin breakdown. By keeping the skin dry and clean you are reducing moisure and reducing the amount of bacteria on the skin that may cause an infection.
  • ]Intervention: Reposition the patient every 2 hours or as the patient requests. Rationale: by repostitioning the patient is not kept in one place for too long, preventing sores related to pressure over the body. Repostioning aids in circulation of the blood and helps with condition of the skin.
  • ]Intervention: Use cushioning devices such as a egg-crate mattress or fleece pad under the pt. Rationale: decreases pressure over bony prominances and skin irritation.
  • ]Intervention: Mobilize/ Ambulate pt to nurses station and back to room t.i.d. Rationale: mobilizing pt will increase circulation and help pt develop the muscles required to ambulate themselves.

Like I said: any input will be greatly appreciated!:D

tiggerdagibit

181 Posts

"Risk for" diagnoses don't have any AEB factors because they don't have the problem, they are just at risk for it. So it would be Risk for Impaired Skin Integrity r/t decreased mobility.

I'm no expert.. just in 3rd semester, but your interventions look good to me. I'm sure Daytonite will be along soon. She gives EXCELLENT care plan advice!

beachgurl_1988

14 Posts

okay, but since I can change this, as I have no real patient, if I just put, impaired skin integrity (without the risk of factor) it looks fine?

tiggerdagibit

181 Posts

I think so. Have you learned about pressure ulcers yet? If so, you may want to be a little more descriptive with the skin breakdown, such as.. stage 1 pressure ulcer on sacral area.. or something like that.

Daytonite, BSN, RN

1 Article; 14,603 Posts

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

to care plan you are looking for problems. the evidence of problems is what is abnormal about the person's physical examination and/or the complications of the medical condition that they have. so, the first thins you should have done is looked up information about these conditions along with their signs and symptoms as well as the complications of obesity and hypertension. you would have found that hypertension is a complication of obesity.

signs and symptoms of obesity:

  • bmi of 30 or greater

complications of obesity:

  • breathing problems
  • hypertension
    • signs and symptoms
      • b/p over 140/90
      • fatigue
      • headaches
      • lightheadedness
      • dizziness
      • bounding pulse
      • pedal edema
      • blurred vision

      [*]complications

      • stroke
      • heart disease
      • renal disease
      • blindness

    [*]heart disease

    [*]diabetes

    [*]renal disease

    [*]gallbladder disease

    [*]early death

    [*]psychosocial problems

i do not know where you got your information that people who are obese develop skin breakdown on their back and thighs, but that sounds bizarre to me unless you are referring to someone who is morbidly obese and can't move. the only skin breakdown i am aware of occurs in the folds of the skin--skin on skin--due to irritation and infection and often because people don't wash regularly, sweat a lot or are so fat they can't reach those areas to be able to wash and dry them properly. this is, again, morbid obesity. not everyone who is obese is morbidly obese. if you go to the websites of any of the obesity surgeons they will list out the complications/reasons for doing the surgery: things such as sleep apnea, exertional asthma, type ii diabetes, metabolic syndrome (hypertriglyceridemia and low levels of high-density lipoprotein cholesterol, elevated blood pressure, impaired glucose tolerance, and central obesity), back and joint problems, menstrual problems, and depression. if i'm not mistaken, they don't do surgery unless a patient has a bmi over something like 40 or more.

a "risk for" diagnosis is for a potential problem--one that doesn't even exist. therefore, there can be no "aeb" evidence to support the nursing problem because it is a non-existent problem. interventions for these kinds of diagnoses are limited to:

  • strategies to prevent the problem from happening in the first place
  • monitoring for the specific signs and symptoms of this problem
  • reporting any symptoms that do occur to the doctor or other concerned professional
  • if symptoms occur, you have an actual problem on your hands and you need to re-evaluate the care plan and change the nursing diagnosis

see this post for more about "risk for" diagnoses: https://allnurses.com/forums/2751313-post8.html. all the interventions you list are for an actual skin problem, not a potential problem. your interventions don't match with the nursing diagnosis.

there are actual nursing problems you should be addressing first, such as imbalanced nutrition: more than body requirements. if you have a nursing diagnosis book you can see examples of interventions you can use with the nursing diagnosis of sedentary lifestyle. these diagnoses both address real nursing problems with real symptoms that obese patients have

with hypertension you can use fatigue and ineffective tissue perfusion: cardiopulmonary due to the poor perfusion and tissue oxygenation created by physiologic changes that are occurring in the person's blood vessels as a result of the hypertension. patients with hypertension are at a risk for strokes and heart attack, so risk for injury is appropriate to use. the pathophysiology of hypertension is posted on this thread: https://allnurses.com/forums/f50/help-pathophys-hypertension-295077.html

beachgurl_1988

14 Posts

Thanks. The problem is I have no real patient. There are just a bunch of topics my instructor put on the board and told us to pick two. There is no patient to base my information off of. I did do research, but feel like I am going in circles, as I have no real pt. We received little to no info about concept mapping, just a few paragraphs in our books.

As for the skin breakdown, since I have no real pt, I am thinking, okay, someone who is obese ( and I am thinking very obese) is not going to be up and mobile as much as someone who is smaller. So, they may spend a lot of time in a bed or chair etc.

I am only in my third term, we only started in January, so I am not very far. I don't really understand the whole concept. I quess I will ask my classmates on Monday what they think.

Daytonite, BSN, RN

1 Article; 14,603 Posts

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

do not misunderstand what i am going to say because i am not being mean. i am trying to teach you. and it does not sound like you are basing your work on logical thinking which is what we have to do as nurses. it sounds to me like you are basing some of your work on what you think you might know about obese people. that is not very scientific, nor the way of good studying. nursing school is teaching you to primarily be a problem solver. to do that they have given you one major tool to accomplish that: the nursing process. in fact, you have been using a form of the nursing process in your daily life to solve problems successfully but never associated it with nursing or it's five steps. for nursing school. and particularly when you get stuck with doing an assignment like this, using it will help put you in the right direction.

the steps of the nursing process are:

  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)
  2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. planning (write measurable goals/outcomes and nursing interventions)
  4. implementation (initiate the care plan)
  5. evaluation (determine if goals/outcomes have been met)

to begin any care planning you must focus your time and activity on the first step--assessment. it doesn't make any difference if the patient is real or not. this is a tool that is assisting you in determining problems so you can then make some educated decisions. all you need to get started (and your instructors know this) is a medical disease or condition. that's why you were all just given a bunch of topics on the board and told us to pick two. the point of this exercise is to take the two topics and learn as much about them as you can. this included learning about their pathophysiology, causes, signs/symptoms, usual tests ordered, the complications of these tests, the medical treatment that the physicians order, and complications of these diseases or conditions. all of these things need to be known to add to your bank of knowledge in order to be able to think critically when making decisions. i know this because i have been a nurse for many years and i understand that this is information that you must know. you either learn it now or you will surely be forced to have to learn it on the job or you will run into serious practice problems, assuming you are able to pass the nclex first. nursing school isn't just learning about nursing. you also have to learn about all kinds of medical diseases and how doctors treat them.

if you need a more practical application, on the nclex and on your nursing school tests you will most likely need to know this information (pathophysiology, causes, signs/symptoms, usual tests ordered, the complications of these tests, the medical treatment that the physicians order, and complications of these diseases or conditions) in order to answer questions correctly and because you will probably have patients in clinicals with these conditions. i've been in and out of school over the years and i would be willing to bet that the list of medical diseases and conditions that your instructor listed on the board was not random! i hope someone in your class copied them all down because i would be willing to bet that you are all going to be responsible for needing to know about all of them. i would expect that questions about all of them are going to show up on future tests. you will probably have patients with these diagnoses and end up having to do nursing care plans about these things. your instructors are probably trying to save you from having to do a lot of reference work down the road.

some time ago i posted a list of weblinks where students could find information about the treatment of medical diseases to help them. although many of the sites are consumer based, they are, at least, easy to read. use them to help you find specifics or verify what is or is not in your textbooks.

before you do anything related to care planning or concept mapping (a concept map is only one type of a format presentation of a care plan) you still must go through performing the steps of the nursing process. in fact, many instructors want students to make concept maps because they help students to see how the nursing process fits in with care planning. because this is the first time you have done this the light bulb hasn't clicked on yet for you, but it will.

when you get more time you can read the information and look at the weblinks about concept maps in nursing as they relate to writing care plans on this sticky thread:

until then, this webpage explains how a nursing care plan is presented as a concept map: http://cord.org/txcollabnursing/onsite_conceptmap.htm. and this sticky has more information on how to write a care plan:

but, you still have to have complete the first 3 steps of the nursing process to be able to start concept mapping. and what your instructor and i both know is all you needed to start out with was the name of a disease. from researching the disease you supply the rest. the more information you learn, the better your care plan and decision-making will be.

i never got into the second and third steps of the nursing process for you because i felt there had been a problem that needed resolving at the assessment level. the abnormal assessment data is used to determine what the nursing diagnosis is. all nursing diagnoses have defining characteristics (symptoms) listed for them. your patient must have at least one or more of the defining characteristics (or risk factors, in the case of a risk for diagnosis) as well as meet the definition of that diagnosis in order for you to be able to assign it to the patient. after that your nursing interventions are aimed at dealing with the patient's symptoms (the evidence that supports the existence of this problem) or its underlying cause. goals and outcomes are the predicted results you expect to happen when your nursing interventions are performed. it's all one big circle of rational thinking.

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