So ridiculous.

[mariaberry19]

Was almost done with my nursing care plan until my instructor tells me it's wrong and I should choose another nursing diagnosis! (sigh). Don't. Understand. General info on patient: Patient overweight. Consumes 4 oz liquid /day. No breakfast &snacks throughout the day. Eats 44% of meals but is overweight/ has HTN. Admit reason: pulmonary embolism as a result of deep vein thrombosis caused by bacterial knee surgery. Patient has contractures of upper extremities. Pain and edema in right leg (where thrombosis occurred). Patient refuses physical therapy. Immobile and gets up only to use restroom & bathe--both w/assistance. My dx taken from NANDA: Risk for skin integrity r/t chronic edema secondary to postthrombalitoc syndrome & immobility AEB pitting edema (1+). Subjective: Patient states she discontinued physical therapy. Objective: Patient immobile. Mobility occurs only to bathe and use restroom What is wrong with my DX?? Confused& stressed!!!

[lwhitten]

We are discouraged to use"risks" when patients could actually have so much more.

[mariaberry19]

i'm so lost.

[mariaberry19]

The guidelines state we can use an actual or a risk dx on the nurse care plan.

[kistigirl]

I'm having the same problem!! Wow!

[BeenThereDoneThat74, MSN, RN]

The guidelines state we can use an actual or a risk dx on the nurse care plan.

Of course, you CAN. But if something already exists, it is more important than something that MAY (or may not) exist.

Like many many test questions you will encounter, it's. it wrong, it's just not the best :/

[mariaberry19]

I figured since this is the first care plan that I've ever done, it would be safe to stick with risk for since it's easier and allowed.

[Stephalump]

You did a great job assessing her nutritional status. What about your assessment directly related to her PE (circulatory/respiratory, etc).

[mariaberry19]

The only information that I received from after observing the patient and talking to the patient herself was:

"When I stand my feet feel heavy like something is holding on to my ankles". "When i'm sitting in my wheel chair, I start aching"

There was visible pitting edema +2 in her lower extremities and her skin looked stretched and shiny. Her right leg where the deep vein thrombus originated was bigger than the left leg. The patient stated "they tell me to raise my legs, but I can't because I can't reach them (patient has osteoarthritis in hands and shoulders) and I don't want to bother anyone because I know they are all on the run constantly"

I was trying to work with this information and see what can be done for her to prevent pain and swelling and possibly suffering another deep vein thrombosis due to not being able to get up and move around as she discontinued physcial therapy by choice and don't want to bother the nurses to help her move around.

[4boysmama]

I'd want to know why she d/c PT? Why's she so immobile? Is she having DOE? (which would be related to the PE, perhaps?) Your priority here should really be on airway/respiration with that PE, followed by the HTN and nutrition. Some possible options: Activity intolerance, decreased cardiac output, chronic pain (from the arthritis)

FWIW, she could be malnourished AND overweight - they're not mutually exclusive. So, even though she's overweight, your dx could still be altered nutrition/less than body requirements. you could even do something like ineffective health maintenance (b/c she quit PT and isn't eating), but that wouldn't be a highest priority.

[SunshineDaisy, ASN, RN]

We were always taught to do ABC's for top priority in care plans and that risk for dx was never first.

[mariaberry19]

These are what I have come up with so far. Let me know what you guys think. I appreciate all the help!

I can't use any words in my nursing diagnosis that would be a medical dx (ex. pulmonary embolism, hypertension)

1. Activity intolerance related to inadequate motivation secondary to pain

2. Functional incontinence r/t impaired mobility AMB muscle weakness.

3. Disturbed sleep pattern r/t frequent awakenings secondary to urinary problems AEB “I think the Lasix is what causes me to urinate a lot at night when I’m resting.”

4. Impaired comfort r/t unmet dependency needs AMB by patient statement “Sometimes I’m afraid to ask the [health care personal] for assistance.”

5. Decisional conflict related to risks versus the benefits of physical therapy AEB patient’s statement “I feel like [physical therapy] won’t help me but will cause more pain.”

6. Fear r/t financial insecurity

7. Excess fluid volume related to swelling of the lower extremities AMB taut, shiny skin secondary to dependent edema.

8. Risk for bleeding r/t to hx of falls AEB patient statement “I am rather clumsy”

9. Risk for electrolyte imbalance r/t fluid imbalance AMB client only consumes 4 ounces of water three times a day.

[twinmommy+2, ADN, BSN, MSN]

I see what you wrote for your diagnoses, but I think like others have posted, that you are still missing the critical issue of her PE. You are focusing on her being overweight and not complying with PT. Step past that issue. What was the issue that brought her into the hospital in the first place? What kind of issues does having a PE cause? You have to focus on what will kill her first, then fix the other issues. Things that will come later like all the risk for's are last on the list, you have to fix the other stuff first.

Cardiac output, decreased

Gas exchange, impaired

Pain/Discomfort

then

Activity intolerance (specify level)

Self-care deficit (specify level): feeding,bathing/hygiene, dressing/ grooming, toileting

Coping, individual, ineffective

Disuse syndrome, risk for