Heeelpppp please! I need to make sure im on the correct route w/ my dx

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HELLO everyone!

i was hoping that someone would be able to confirm that i am on the right track with my nursing dx's for a situation that my teacher assigned me and i need help with the RTs AND AEBs.. so all feedback would be greatly appreciated!:mad:

Mr. Jones, aged 68, experienced a stroke 1 week ago that left him with right-sided weakness, aphasia and incontinence. His wife is eager to have him discharged from the hospital so that she can care for him at home. You have heard her tell Mr. Jones, "You don't need to worry about a thing, honey. I will take complete care of you and do everything for you. All you have to do is stay in bed and take it easy."

so far all i have:

Impaired swallowing RT aphasia secondary to CVA

Impaired verbal communication RT aphasia secondary to CVA AEB inability to communicate

Impaired physical mobility RT right sided weakness secondary to CVA AEB poor balance and weakness

Self care deficit RT acute disease process secondary to CVA AEB right sided weakness aphasia and incontinence

Risk for aspiration RT right sided weakness secondary to CVA

Risk for impaired skin integrity RT incontinence and right sided weakness

Knowledge deficit of caregiver of current dx and prognosis AEB ???

Risk for imbalanced nutrition: less than body requirements

risk for injury RT right sided weakness

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Specializes in VA-BC, CRNI.

What stuck out to me in this scenario is how is he going to be cared for? If he is 68 I assume his wife is not a 22 year old with the body of an olympian.

This scenario screams of risk of caregiver role strain and knowledge deficit.

Besides the usual CVA stuff think about the situation. You are not only his Nurse but your also the families. Does her statement make sense? Do you think she will be able to adequately take care of him? Hell I am a 26 year old male in good physical condition I don't think I could take care of someone like that alone. Besides do you want your pt to stay in bed and do nothing?

"Knowledge deficit of caregiver of current dx and prognosis AEB her ridiculous statement."

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LOL! NO really! this is killin me! i really don't know how i should word a few of my dx's

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Specializes in VA-BC, CRNI.

I am telling you that this scenario centers around the wife, not the husband. This does not mean not include the his Dx but you need to focus upon the scenario and the wife is the primary Dx.

What is the center of the problem facing you?

Your automatically focusing upon the medical side of the problem but remember there is a difference between medicine, what MDs practice, and Nursing.

If this scenario said CVA right sided deficit and thats it, then your Dx would be fine but it doesn't. Most of the scenario talks about the wife and her statement...the pt's info is only a background to the problem giving it depth and scope. The problem is the wife.

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ok so i understand that the wife is a huge problem, but are any of my dx's correct for the situation

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ok so i understand that the wife is a huge problem, but are any of my dx's correct for the situation

I don't think you seeing the big picture. Critical thinking needed here-

His wife is one of his biggest problems- how will the pt ever recover or even maintain what abilities he has left if his wife is doing everything for him?

In my mind her statements are a big red flag.

Besides all this, your NDX are fine.

The big priority in this situation is lots of teaching for the wife and pt re: her statement.

Excellent post below:

I am telling you that this scenario centers around the wife, not the husband. This does not mean not include the his Dx but you need to focus upon the scenario and the wife is the primary Dx.

What is the center of the problem facing you?

You're automatically focusing upon the medical side of the problem but remember there is a difference between medicine, what MDs practice, and Nursing.

If this scenario said CVA right sided deficit and thats it, then your Dx would be fine but it doesn't. Most of the scenario talks about the wife and her statement...the pt's info is only a background to the problem giving it depth and scope. The problem is the wife.

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Specializes in VA-BC, CRNI.

impaired swallowing rt aphasia secondary to cva

impaired verbal communication rt aphasia secondary to cva aeb inability to verbally communicate

impaired physical mobility rt right sided weakness secondary to cva aeb poor balance and (do you know he has poor balance? i would leave it at weakness) weakness

risk for self care deficit rt acute disease process secondary to cva aeb right sided weakness aphasia and incontinence

risk for aspiration rt right sided weakness secondary to cva

risk for impaired skin integrity rt incontinence and right sided weakness

knowledge deficit of caregiver of current dx and prognosis aeb ??? statement

risk for imbalanced nutrition: less than body requirements don't know that he is, maybe he eats just fine? maybe too much? i would say you could include this but it is weak.

risk for injury rt right sided weakness i would say risk for falls r/t right sided weakness.

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Your primary NDX should address the wife's statements.

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no, i do understand that, and i do have a knowledge deficit dx up there, i just wasnt too sure if i could actually put her whole entire statement in my dx, that is all.. and im implying about the other dx because i wanted to make sure that i was wording them correctly with the right RTs and AEBs.. thanx for your help

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Specializes in Emergency Dept.

what first popped into my head was possible knowledge deficit r/t disease process and a risk for caregiver role strain or something along those lines. the pt's so might be anxious to be the one to care for the pt, but in time, it might be more than the so can handle. good luck with this. :)

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Yes, you can put in the wife's entire statement under AEB.

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

the first thing i noticed is that you misdiagnosed the patient. aphasia is the inability to speak. aphagia is a problem with swallowing. unless you made a typo, this patient does not have a swallowing problem, so your diagnoses of impaired swallowing and risk for aspiration need to be removed.

in priority order, based on what you posted, i would diagnose the following:

  • total incontinence r/t neurological impairment secondary to stroke aeb (incontinence)
  • impaired physical mobility r/t neurological impairment secondary to stroke aeb right-sided weakness
  • impaired verbal communication r/t neurological impairment secondary to stroke aeb aphasia
  • self care-deficits r/t neurological impairment secondary to stroke aeb (?)
  • caregiver role strain r/t inexperience and knowledge of caregiver aeb statement by wife "you don't need to worry about a thing, honey. i will take complete care of you and do everything for you. all you have to do is stay in bed and take it easy.

r/t's are the underlying cause of the problem; aeb's are always the symptoms that prove the existence of the problem.

- - - - - - - - - - - - - - -

impaired swallowing rt aphasia secondary to cva

aphasia is not difficulty swallowing.

impaired verbal communication rt aphasia secondary to cva aeb inability to communicate

aphasia is not the etiology, or underlying cause, of the
impaired verbal communication
(definition:
decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols.
page 178,
nanda international nursing diagnoses: definitions and classifications 2009-2011
.) anyway, it is a medical diagnosis and should not be used in a nursing diagnostic statement. the cva is the cause of the aphasia, but must be stated in a more general way, such as neurological impairment or as alteration in central nervous system.

impaired physical mobility rt right sided weakness secondary to cva aeb poor balance and weakness

right-sided weakness is a
symptom
of the
impaired physical mobility
and not the underlying cause of it. again, the cva is the cause of it, but must be stated in a general way.

self care deficit rt acute disease process secondary to cva aeb right sided weakness aphasia and incontinence

self care deficit is the inability to perform adls. what acute disease process is going on to cause self-care deficits? the r/t factor is neuromuscular impairment secondary to the cva or possibly, in this case, the patient's inability to perceive a body part. insofar as the symptoms are concerned, right sided weakness, aphasia and incontinence are not self-care deficits. bathing, dressing, movement, eating, toileting, dressing and grooming fall into that category.

risk for aspiration rt right sided weakness secondary to cva

not applicable since aphasia is not a swallowing problem.

risk for impaired skin integrity rt incontinence and right sided weakness

this is a bit of a stretch, but ok.

knowledge deficit of caregiver of current dx and prognosis aeb ???

you can't diagnose the wife. the careplan is about the patient, not the wife. the focus has to be on the patient and what will happen to him, not his wife.

risk for imbalanced nutrition: less than body requirements

have no idea how you concluded this was a problem.

risk for injury rt right sided weakness

i wouldn't diagnosis this. interventions for this can be included with
impaired physical mobility
.

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