Help with careplan

[stevosmusic]

I need help! I have a careplan due tomorrow and I can't figure out what my patients most pertinent diagnosis is. Hopefully sharing isn't against HIPPA. I won't share any personal info. Anyways patient is in a long term care facility. His charts say his diagnosis are COPD, Dementia, Age-related osteoporosis, Inflammatory Liver Disease (hepatitis), GERD w/o esophagitis. Hypo-osmolality and hyponatremia, pain, mild-protein-calorie malnutrition, Nutritional deficiency, constipation, and Hyperlipidemia. I need to find the most "peritnent" diagnosis and I don't know which one is the most important. They all seem pretty big to me. And on top of that my patient is on antidiabetic meds. He also has a lipid panel test which shows high Triglycerides and low HDL. Which the test and the med are telling me he has type 2 diabetes. but he is only on the antidiabetic he has no insulin. Should I put diabetes as a diagnosis? and what is the most pertinent?

Thanks!

[nursej22, MSN, RN]

This is probably too late to help with your assignment, but your nursing diagnoses should be based on your assessment, not his medical diagnoses. Sure, COPD sounds pretty important, but how was his breathing? Labored, rapid, wheezing, crackles? His oxygen saturation? Other vital signs? If these were all normal, then this would not be the most important, or priority problem.

Was he in pain? A fall risk? Did have skin break down? Liver disease may put him in fluid imbalance, encephalopathy, bleeding risk...

My broad rule of thumb, although crude is "what is going to kill them first?"

[stevosmusic]

Thanks for the reply! I turned it in already! He did have wheezing and was on s bronchodilator and corticosteroid. I ultimately chose COPD my patient seems to be very health overall after my assessment. My main concern was the wheezing! Thanks!

[Sierrac11]

I would have chosen COPD as well, ABC's ! :)

[stevosmusic]

that's why I chose it! :)

[Leonardsmom,LPN]

The thing is with nursing diagnosis they need to be based upon your assessment and the needs of the patient, not their medical diagnosis. So with a patient with COPD you might want to think about if they have activity intolerance, do they have to stop often when doing something like getting dressed? Are they able to walk, how far can they walk. What is their oxygen saturation, how is it with activity? Do they need assistance with dressing, bathing? How is their social interactions, do they avoid being around people because of a chronic cough they may be embarrassed about.

There are some really good posts here in the nursing student assistance forum by Esme12 and grntea that are very informative for students learning how to make nursing diagnosis that you might find to be helpful in the future. Good luck.