help with care plan!

mfc2008 · Jul 4, 2008

are these okay diagnoses?

deficient knowledge related to precautions and self-care after total abd hysterectomy and salpingo-oophorectomy.

coping or grieving r/t change in body image, loss of reproductive status.

mfc2008 · Jul 4, 2008

are these okay diagnoses?

deficient knowledge r/t precautions and self-care after total abd hysterectomy and salpingo oophorectomy.

coping or grieving due to body image, loss of reproductive status.

vballmanrn · Jul 4, 2008

are these okay diagnoses?
deficient knowledge related to precautions and self-care after total abd hysterectomy and salpingo-oophorectomy.
coping or grieving r/t change in body image, loss of reproductive status.

In our program, educational diagnoses had to have regarding and related to factors in them. So it would say:

Ineffective health maintenance r/t deficient knowledge regarding precautions and self-care following surgery.

For psycho-social:

Anticipatory grieving r/t change in body image, loss of reproductive status.

Hope this helps!!

Erick, RN

Daytonite, BSN, RN · Jul 4, 2008

i just posted to a thread yesterday about a care plan on a patient who was depressed after a hysterectomy (https://allnurses.com/forums/f50/depression-r-t-incapability-bear-child-314693.html - need information - depression r/t incapability to bear child). i absolutely hate working with psychosocial diagnoses. i'll tell you why. first of all, you have to be able to assess for the signs and symptoms (defining characteristics) of these diagnoses. do you have a list of them somewhere? you are wanting to use coping or grieving. that means you need to be able to identify abnormal coping and grieving behavior. now, i know that i can find some of that information in the nanda taxonomy, but that is just a shortcut. you also have to know what the definitions of these diagnoses are so you are using the diagnosis correctly. the other problem is that once you know what these symptoms are, how are you going to treat them? in other words, what are your nursing interventions going to be? and, i'll tell you that without an ob textbook and not going to a library i had a devil of a time finding information on depression after hysterectomy because most of the information on the internet is for the general public, not for professionals.

that's my rant for the day.

coping

grieving

i posted those websites for you so you could see the nanda taxonomy information. you want to look at the related factors that nanda lists for these diagnoses. related factors are the etiologies, or causes, of these nursing problems.

coping or grieving due to body image, loss of reproductive status

there is no diagnosis of

coping

. there is

ineffective coping

and

defensive coping

and a couple of family coping types. yes, this diagnosis can be used but it's related factor has to do with something interfering with the person's normal

ability to deal with a stressful situation

(the definition of this diagnosis). so, what would that be? body image or loss of reproductive status is not what interferes with the person's ability to cope--they are more like triggers. something deeper is the cause. that's why i don't like these psychosocial diagnoses. the trigger is either a threat, tension, a challenge to their adaptive energy, a challenge to the persons ability to control, they feel they don't have support to cope and there are others. look at the webpage and see if any of the reasons that nanda lists fit. i don't think any do.

grieving, however, is different. look at what i posted on the thread i linked you to above.

grieving r/t loss of the ability to bear children aeb [her symptoms: is she. . . sad? angry? blaming herself? trying to make some kind of meaning out of this event? having difficulty sleeping?]

deficient knowledge r/t precautions and self-care after total abd hysterectomy and salpingo oophorectomy

deficient knowledge has to be specified. and, the related factors for this diagnosis have to do with the reason (cause, or etiology) of

why they can't

acquire the information. forgive my sarcasm, but a person has a knowledge deficit because they are dumb, don't want to learn, apathetic, don't have access to the information, or just don't know where to go to find the information in the first place. often it's due to a lack to information, but occasionally you'll run into patients that just don't want to learn. so, this diagnosis should be worded as

deficient knowledge, hysterectomy r/t lack of information.

i don't know what interventions i would be able to do besides teaching the patient about the surgery. i feel like there is more that i could do but i'm having a brain fart and can't think of any other interventions.

part of your problem was that you diagnosed this wrong. interventions are always treating the symptoms. i already told you that i wouldn't use a coping diagnosis. i would use

grieving.

i listed the symptoms of grieving on the

need information - depression r/t incapability to bear child

post. that is going to take care of your patient's depression and body image problem. all you need to do is look for nursing interventions for some of those symptoms. i am sure you can find interventions for anger and sadness! as for the knowledge deficit you can go to all kinds of web sites on hysterectomy as well as your textbook to get

aftercare

instructions or use the weblinks on this thread:

https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites

the patient needs to know about any dressing changes, incision care, activities, showering, hormone replacement therapy and follow up appointments with the surgeon.

Daytonite, BSN, RN · Jul 4, 2008

in our program, educational diagnoses had to have regarding and related to factors in them. so it would say:
ineffective health maintenance r/t deficient knowledge regarding precautions and self-care following surgery.
for psycho-social:
anticipatory grieving r/t change in body image, loss of reproductive status.
hope this helps!!
erick, rn

ineffective health maintenance r/t deficient knowledge regarding precautions and self-care following surgery

i've worked with this diagnosis a lot. it gets used when

noncompliance

doesn't quite fit.

i

neffective health maintenance

is defined by nanda as the

inability

to identify, manage, and/or seek out help to maintain health.

the keyword in this definition is "inability".

inability

means unable, incapable, powerless, incompetent, or no skill at. with

ineffective health maintenance

the patient may not know/understand why they are not able to follow the plan of care, may not care, or may not mentally or physically be able to. the bottom line reason, or etiology, for their

inability

to identify, manage, and/or seek out help to maintain health

is what becomes the r/t part of the diagnostic statement. if deficient knowledge is the reason for someone not getting healthcare, then use the

deficient knowledge

diagnosis. nanda is very specific about the etiologies for this diagnosis:

history of lack of health-seeking behaviors [misses appointments, doesn't take medication or perform treatments on a regular basis]
inability to take responsibility for meeting basic health practices [this would be blaming others/passing the buck]
lack of expressed interest in improving health behaviors [statements like: "it's not going to make any difference if i take my medicine or not."]
demonstrated lack of knowledge regarding basic health practices ["mama always taught us to (do some bizarre thing to cure a fever)"]
demonstrated lack of adaptive behaviors to environmental changes

anticipatory grieving r/t change in body image, loss of reproductive

status

i explained in

https://allnurses.com/forums/f50/depression-r-t-incapability-bear-child-314693.html

-

need information - depression r/t incapability to bear child

that

anticipatory grieving

was deleted and changed by nanda to

grieving

for the 2007-2008 list.

mfc2008 · Jul 4, 2008

well my patient at the time seemed fine with the surgery. she wasn't in any pain, and was actually very pleasant. So i was unsure what kinds of interventions i would do if i was to do coping because she wasn't really depressed, she actually seemed happy and was smiling and joking around with her husband and family. perhaps a "risk for" type diagnosis would work???

vballmanrn · Jul 5, 2008

well my patient at the time seemed fine with the surgery. she wasn't in any pain, and was actually very pleasant. So i was unsure what kinds of interventions i would do if i was to do coping because she wasn't really depressed, she actually seemed happy and was smiling and joking around with her husband and family. perhaps a "risk for" type diagnosis would work???

Yes, a risk for nursing diagnosis could be appropriate.

Daytonite, BSN, RN · Jul 5, 2008

well my patient at the time seemed fine with the surgery. she wasn't in any pain, and was actually very pleasant. so i was unsure what kinds of interventions i would do if i was to do coping because she wasn't really depressed, she actually seemed happy and was smiling and joking around with her husband and family. perhaps a "risk for" type diagnosis would work???

you keep mentioning coping. unless you know how to assess for coping i really recommend that you stay away from this diagnosis. i posted a list of the psychosocial diagnoses, if that's what you need, on post #146 of this sticky thread some time ago: https://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - desperately need help with careplans. deficient knowledge (specify) is classified by nanda as a psychosocial diagnosis. now, your nursing program may not agree with that. but, you say this patient is "fine with the surgery". then, i suggest that for a psychosocial diagnosis you use readiness for enhanced therapeutic regimen management. it is one of the wellness diagnoses. its definition is "a pattern of regulating and integrating into daily living a program for treatment of illness and its sequelae that is sufficient for meeting health-related goals and can be strengthened". (page 224, nanda-i nursing diagnoses: definitions & classification 2007-2008). if you know someone who has a copy of nursing diagnosis handbook: a guide to planning care by betty j. ackley and gail b. ladwig you can see the interventions listed for this diagnosis include not only teaching about their medical condition, but going out into the community and utilizing support groups to assist with self-management and direction. you can also guide the patient to websites about hysterectomy and hrt information--that gives you your psychosocial tie in because it encourages and supports her self-direction (think of it as self-serve healthcare) to do this. that's what wellness is all about--self-serve, doing it on their own, because they have no legitimate need (at least the insurance companies won't pay for) to access and pay for healthcare services.

don't give her a nursing problem she doesn't rightfully deserve! do you have to meet a minimal number of nursing diagnoses for the care plan for school? if that is the case, then if you want to care plan for a potential problem in a surgical patient all you need to do is consider the complications of general anesthesia and total abdominal hysterectomy

complications of general anesthesia:
- breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
- hypotension (shock, hemorrhage)
- thrombophlebitis in the lower extremity
- elevated or depressed temperature
- any number of problems with the incision/wound (dehiscence, evisceration, infection)
- fluid and electrolyte imbalances
- urinary retention
- constipation
- surgical pain
- nausea/vomiting (paralytic ileus)
[*]complications of total abdominal hysterectomy (some of the same as above):
- urinary retention
- abdominal distention
- accidental injury to the ureter or bowel
- wound dehiscence
- paralytic ileus
- psychological problems
- infection

i worked for many years in med/surg. i've also had 4 abdominal surgeries myself, including a tah/bso. make sure you teach this patient about hrt (hormone replacement therapy), why she needs to be on it, that it is something she will need to take daily for many years to come, the potential risks and the importance of having bone density scans done regularly as she ages. a post op wound infection that can lead to sepsis as well as and/or dehiscence can happen after the patient is discharged. so can atelectasis and pneumonia. the complete return of peristalsis can be manifested by bouts of nausea and anorexia for as long as 6 weeks until the gi system gets up and running again.

mfc2008 · Jul 5, 2008

thank you so much! that REALLY helped. I completely forgot about using the wellness diagnoses. yeah, i was stuck because she didn't fit any of the other diagnoses but all of the examples that i was finding were related to the illness rather than the wellness. thank you so much for reminding me about those!

Daytonite, BSN, RN · Jul 5, 2008

you are welcome. i'm glad you are working on this now. i understand that as a student the instructors sometimes give you certain parameters that you have to follow. they are trying to help you get acquainted with the different diagnoses that are available. when you have your license and are working you will pretty much be able to diagnose as you want and not have to deal with having at least one of this kind of diagnosis and one of that kind of diagnosis. in the working world the written care plan is looked at as documentation of your decision making process.