help with care plan!

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

• ineffective coping
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=15
  

grieving

• grieving
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=24
  

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

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

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.

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

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

• 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

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.

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.