Gangrene nursing diagnosis

StudentOfHealing · Aug 24, 2013

Oh this is a good one(:

and being that I'm still on break from school until Monday, I have time to spare!

Have y'all covered renal failure?

What caused the ESRD?

What are his labs? (look at K+)

Is he on Tele?

What's his diet? (dialysis patients have a special diet and typically these patients, from my textbook learning, are deficient in one macromolecule, research it)

You say he's at risk for falls? Why?

What about his tissue integrity?

What's his Blood glucose?

What are his meds? any teaching?

Does he complain of any pruritis?

Describe his bowels?

What are his bowel patterns?

What about his emotional state?

I don't wanna give out too much. You gotta think now(: Hope it got some wheels rolling.

There's a bunch of stuff just yelling here! "pick me" "pick me"

Good luck!!!

StudentOfHealing · Aug 24, 2013

His pulse is 20?

StVitusDanceRN · Aug 24, 2013

Ineffective cardiac output is his hr is 20. He has some serious perfusion issues going on.

Esme12, ASN, BSN, RN · Aug 24, 2013

HI! We;come toAN! The largest online nursing community!

We a happy to help but we need your input first....What semester are you? What care plan book do you use?

medical dx closed head injury and ESRD.Hx:diabetic, dry gangrene(male organ), fall risk, peripheral neuropathy. Assessment: bp 97/65, T 98.5, O2 100%, resp 20, pulse 20. pain level 3 (0-10 pain scale), coccyx pressure ulcer was pinkish about an inch wide, on pain meds prn. He's on fluid restriction. No urine output bcoz he goes to dialysis 3x/ wee

What is gangrene of the male organ? It has a name.......Fournier gangrene. What is Fournier gangrene?

You have told me this patients medical diagnosis but nothing about his assessment except his vital signs...Are you sure his pulse is 20(twenty) beats per min? What does the skin look like? Is there edema? What are the labs?

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

KelRN215, BSN, RN · Aug 24, 2013

Hi everyone. I have to make a care plan for my pt. But until now im still having trouble making a nursing Dx for this pt. medical dx closed head injury and ESRD.Hx:diabetic, dry gangrene(male organ), fall risk, peripheral neuropathy. Assessment: bp 97/65, T 98.5, O2 100%, resp 20, pulse 20. pain level 3 (0-10 pain scale), coccyx pressure ulcer was pinkish about an inch wide, on pain meds prn. He's on fluid restriction. No urine output bcoz he goes to dialysis 3x/ week. I would appreciate any help or suggestions. Thanks!

If the patient's pulse is 20, I think you need to code him before you worry about writing a nursing diagnosis.

Given all that you've listed that is actively going on with him, I'm not sure a history of gangrene should be your priority to focus on...

rxjm01 · Aug 25, 2013

First, I need to thank you all for answering my questions. It was our first day to go back to clinicals. All of can't log in to any computer to get our labs. Pt on telemetry, renal dialysis diet, dry itchy skin, +1 pitting edema BLE, bowel patterns once qod, fall risk due to syncope, FSBG: 93. Peripheral neuropathy. He was depresse and aggitated bcoz he was been in the hospital for a month.

Meds: Humulin R per SS, Levemir, zofran, Tylenol PRN, protonix,Norco,allopurinol, digoxin,coreg, Coumadin, Bactroban,

Esme12, ASN, BSN, RN · Aug 25, 2013

. All of us can't log in to any computer to get our labs. Pt on telemetry, renal dialysis diet, dry itchy skin, +1 pitting edema BLE, bowel patterns once qod, fall risk due to syncope, FSBG: 93. Peripheral neuropathy. He was depressed and agitated because he was been in the hospital for a month.
Meds: Humulin R per SS, Levemir, zofran, Tylenol PRN, protonix,Norco,allopurinol, digoxin,coreg, Coumadin, Bactroban,

and

medical dx closed head injury and ESRD. Hx:diabetic, dry gangrene(male organ), fall risk, peripheral neuropathy. Assessment: bp 97/65, T 98.5, O2 100%, resp 20, pulse 20. pain level 3 (0-10 pain scale), coccyx pressure ulcer was pinkish about an inch wide, on pain meds prn. He's on fluid restriction. No urine output because he goes to dialysis 3x/ week.

Why is he in the hospital right now......Why has he been in the hospital for a month? What is his current diagnosis? Head injury? How did he get that injury? What does renal failure do to the body? What do these patients typically need? How do you know he is depressed and angry/agitated? What did he say?

What else? Anything in your assessment for the Fournier gangrene? or is that an old diagnosis? What would the symptoms be? What is the standard of care? What else about his skin? How is his turgor? What are his lung sounds? Why has he been in the hospital for a month? What is your assessment? What are the vital signs? IS HIS HEART RATE REALLY 20bpm????? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. What is YOUR scenario? Of course he is depressed he has gangrene of his member....that's enough to upset any man...... TELL ME ABOUT YOUR PATIENT....TELL ME WHAT SO YOU THING HE NEEDS?? IF THIS WAS YOU WHAT WOULD YOU NEED/WHAT??????

AGAIN.....Let the patient/patient assessment drive your diagnosis. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
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)
Planning (write measurable goals/outcomes and nursing interventions)
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

So tell me about your patient.......What do they need? What do they c/o? What is your assessment......What does this tell me about the patient?

StudentOfHealing · Aug 25, 2013

Hope someone addressed that HR 20 by now. Hehe. Kidding..

lmccrn62, MSN, RN · Aug 26, 2013

Nursing care plans are a pain. It is how you think as a nurse to address the needs of your patient. Just what you listed are plenty of nursing diagnoses.

Skin integrity- he has pressure ulcer, itching

Elimination- he does not void related to ESRD.

Labs- does he have abnormal lab values?

Head injury- ??? Is he confused, did he fall??

Mobility- gait issues that cause him to fall.

So think like a nurse not a doctor the gangrene may or may not be a current issue. Pick nursing diagnoses that are affecting him currently. Look at the NANDA diagnoses and refer to your patient you will get it. Good luck!

Esme12, ASN, BSN, RN · Aug 26, 2013

lmccrn62 was very nice to give you some good hints.....What do YOU think?

nurseprnRN, BSN, RN · Aug 26, 2013

Where is your nursing assessment of his condition? This is all medical diagnoses.

See, you are falling into the classic nursing student trap of trying desperately to find a nursing diagnosis for a medical diagnosis without really looking at your assignment as a nursing assignment. You are not being asked to find an auxiliary medical diagnosis-- nursing diagnoses are not dependent on medical ones. You are not being asked to supplement the medical plan of care-- you are being asked to develop your skills to determine a nursing plan of care. This is complementary but not dependent on the medical diagnosis or plan of care.

Sure, you have to know about the medical diagnosis and its implications for care, because you, the nurse, are legally obligated to implement some parts of the medical plan of care. Not all, of course-- you aren't responsible for lab, radiology, PT, dietary, or a host of other things.

You are responsible for some of those components of the medical plan of care but that is not all you are responsible for. You are responsible for looking at your patient as a person who requires nursing expertise, expertise in nursing care, a wholly different scientific field with a wholly separate body of knowledge about assessment and diagnosis and treatment in it. That's where nursing assessment and subsequent diagnosis and treatment plan comes in.

This is one of the hardest things for students to learn-- how to think like a nurse, and not like a physician appendage. Some people never do move beyond including things like "assess/monitor give meds and IVs as ordered," and they completely miss the point of nursing its own self. I know it's hard to wrap your head around when so much of what we have to know overlaps the medical diagnostic process and the medical treatment plan, and that's why nursing is so critically important to patients.

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic" and related factor. Defining characteristics and related factors for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.