Help with care plan

Daytonite, BSN, RN · Apr 22, 2009

the construction of a 3-part nursing diagnostic statement follows this format:

p (problem) - e (etiology) - s (symptoms)

problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
etiology - also called the related factor by nanda, this is what is causing the problem and resulting in the symptoms. pathophysiologies need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. etiologies, if they are other than of a medical source, are often the focus of outcomes and long term goals.
symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they could be signs and symptoms of the medical disease the patient has, their responses to their disease, problems accomplishing their adls. they are evidence that prove the existence of the problem. if you are unsure that a symptom belongs with a problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

let's look at your diagnosis. . .

impaired gas exchange r/t: pulmonary immaturity aeb: extremely premature

problem: impaired gas exchange
- definition: excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane (pg. 112, nanda international nursing diagnoses: definitions and classifications 2009-2011).
[*]etiology: pulmonary immaturity
- this is a medical diagnosis. medical diagnoses are not allowed in nursing diagnostic statements
- the nanda taxonomy actually lists 2 possibilities for the etiologies that can occur for this diagnostic problem and both involve situations that impair the alveoli. how is pulmonary immaturity impairing the function of the alveoli? determine the pathophysiology, state it as concisely as possible and that will be the etiology (related factor) for this diagnosis.
[*]symptoms: extremely premature
- a symptom is a perceptible change in the body or its function. extremely premature is not a symptom. it is a description of the baby's condition at birth: prematurity - born before the 37th week of gestation. prematurity has nothing to do with an excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane. therefore, this is not describing a symptom of this gas exchange problem.
- what is evidence of impaired gas exchange is the apnea every 15 minutes, o2 sat of 85-95%, and the abgs with a ph of 7.32 and pco2 of 37 (they are missing the hco3 result)

nanda has taken every official nursing diagnosis that they have studied (impaired gas exchange is one of them) and listed (1) a definition, (2) related factors (causes for the problem) and (3) defining characteristics (signs and symptoms) for each in its published taxonomy. you can see this taxonomy information printed in nursing care plan books, nursing diagnosis books and the appendix of taber's cyclopedic medical dictionary. these two websites happen to have that information as well as some nursing interventions for this particular diagnosis:

impaired gas exchange
http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=23 - impaired gas exchange

SN09 · Apr 23, 2009

Thanks! Daytonite for your response, it helped me out alot.

sandyzgurl · May 8, 2009

hi,this site aroused me..im a nursing student 2 and has difficulty making nursing care plan,not that tough..wana ask and want an answer for those who truly wana help. im confused with my c.i..can i make pathophysiology without knowing the medical diagnosis,just relying on the cues?? is your nsg interventions dependent on the problem or etiology?or cud be both?..for example the problem is Pain R/L to abdominal incision, does my nsg. intervention should focus on the pain alone?or the etiology...

Daytonite, BSN, RN · May 9, 2009

hi,this site aroused me..im a nursing student 2 and has difficulty making nursing care plan,not that tough..wana ask and want an answer for those who truly wana help. im confused with my c.i..can i make pathophysiology without knowing the medical diagnosis,just relying on the cues?? is your nsg interventions dependent on the problem or etiology?or cud be both?..for example the problem is pain r/l to abdominal incision, does my nsg. intervention should focus on the pain alone?or the etiology...

yes, there are pathophysiologies for some conditions that the patient will have (particularly behavioral problems) that are not medical diseases. you are looking to explain the reason the nursing problem came into existence with the r/t part of the nursing diagnostic statement

for pain r/l to abdominal incision your nursing interventions are generally focused on the evidence of the pain which you did not list. that would be something such as pain r/l to abdominal incision aeb patient statement of pain level of 8 on a scale of 10. your nursing interventions will be for the pain level of 8 on a scale of 10. there is nothing you can do about the abdominal incision which is the cause of the pain. the abdominal incision is an injury to the tissues that has produced pain. doing something about the pain is the focus of the diagnosis. the r/t part of the diagnostic statement is merely telling us readers what the cause of this pain is.

there will be situations when your nursing interventions can focus on and treat the etiology of the nursing problem. when the nursing problems (nursing diagnoses) have a medical disease as the underlying etiology that will not be possible because we are not licensed to treat medical diseases--that is within the doctor's realm. there will be some nursing problems such as ineffective health maintenance r/t unwillingness to cooperate with caregivers aeb blaming wife for his not following the 1600 calorie ada diet restrictions. in such a case, interventions can be done to work with changing the patient's cooperation and willingness, one of the etiologies of the problem. interventions regarding how to correct and make sure the patient follows the diet as ordered would also be appropriate.