psychosocial careplan help for homeless

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I had a homeless patient with pneumonia last week. I'm doing a care plan for him and I already have the physical nursing dx, but I'm having a really difficult time coming up with the psychosocial nursing dx for him. He's homeless, his family lives in a different state, but he seemed really happy to be in the hospital where it's clean and warm and he's fed.

Anxiety generally fits everyone in the hospital, but not this dude. He doesn't qualify for State services because he doesn't have California identification, so I'm thinking the hospital has been the most stable place he's been in some time.

He also drinks 2 6-packs of beer a day and is a pack a day smoker, but wasn't showing any signs of withdrawl from either.

This is due Wednesday, so any help would be greatly appreciated. I can think of several "risk for" diagnoses, but no actuals.

Thanks so much!

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does he have any mental health dx's?

is he depressed?

alt thought process?

alt home maintenance?

leslie

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Nope, no mental health dx. Right middle and lower lobe pna, and early emphysema.

He didn't seem depressed at all. He seemed rather happy when he wasn't having a coughing fit.

He also seemed completely with it. He told me he likes Florida because all you need is a couple beach towels and you're set. Apparently California gets too cold for him.

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

i worked on an alcohol detox unit. if i drank 12 beers a day on a regular basis it's safe to assume it's more like 20 a day. i wouldn't be showing any signs of dts for 5 to 7 days. alcoholics lie. but, hey. . .believe what you want. how does a homeless guy pony up the dough for the beer and smokes? that's 3 social questions/problems right there. what isn't he telling you? did social services evaluate him?

there is a list of the psychosocial diagnoses on post #145 of this thread:

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I had him on day 2 and 3 of his hospital stay. I know homelessness is a problem, but there really is no nursing dx for it. It said in his chart that he drinks 2 6-packs a day. He also smokes a pack a day. I don't know where he gets the money for any of it. Maybe he's one of the guys who stands by the side of the road with a cardboard sign, I didn't ask him.

Social services had been in and was trying to find shelters he can go to when he gets out. His chart said that he'd been unable to go to any shelters because he lacked CA ID. That didn't sound so right to me, but that was what I read.

The way our care plans are set up, we have the problem, related to, and 3 manifested by's that we need to fill in. Then, for each manifested by, we need one evaluation criteria and a diagnostic, therapeutic and educational implementation. Then we have to evaluate whether the criteria were met, if not, we have to modify the care plan for another go.

The thing is, I likely won't see this patient again, so I wouldn't be able to modify the care plan and try again.

My instructor recommended deficient knowledge related to smoking, but I don't know if I could come up with all of the other supporting stuff....

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

How about using Risk-Prone Health Behavior R/T low socioeconomic status? It is a psychosocial diagnosis that deals with coping.

Definition:
Inability to modify lifestyle/behaviors in a manner consistent with a change in health status.

Defining Characteristics (
symptoms
):
demonstrates nonacceptance of health status change, failure to achieve optimal sense of control, failure to take action that prevents health problems, minimizes health status change

(page 18,
NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008
)

Or, make it Risk for Risk-Prone Health Behavior R/T low socioeconomic status since you don't have a lot of information on the patient.

One thing I learned working with the homeless vets at a VA hospital and later at a large intercity tertiary care center was to not be embarrassed to ask patients about sex, STDs, recreational drug use, booze and how they got money to live, where they slept or what they were eating. Many times their social problems were worse than their physical ones.

NOTE: This diagnosis was renamed recently. Previous label was Impaired Adjustment.

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