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Discussion

Help with Dx.

What do I write as a nursing diagnosis for this..?

A client has been having frequent and severe headaches and there is evidence of sleep deprivation, because of busy schedule and frequently feeling fatigued.

..Would I write:

Acute Pain R/T lack of knowledge of pain control techniques or methods to prevent headaches AEB ....?

Or would I do a Dx of Sleep Deprivation R/T____AEB____?...

Its part of a paper I am writing, and its making my head spin. :zzzzz

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  • Experts

Acute Pain R/T lack of knowledge of pain control techniques or methods to prevent headaches AEB patient's complaint of head pain. Question. . .if the patient could control their headaches by simply learning some preventative measures (that would be a goal implied by the related factor you list with this diagnosis), then wouldn't Deficient Knowledge, Pain control methods R/T lack of knowledge be a better diagnosis to use?

There are two diagnoses for sleep problems: Sleep Deprivation and Disturbed Sleep Pattern (sometimes listed as Insomnia). Whether you use either depends on what the patient's symptoms are. Because fatigue is a symptom here, Sleep Deprivation is probably more appropriate to use. The related factor would be "headache". Sleep Deprivation R/T headaches AEB fatigue.

  • Author
Acute Pain R/T lack of knowledge of pain control techniques or methods to prevent headaches AEB patient's complaint of head pain. Question. . .if the patient could control their headaches by simply learning some preventative measures (that would be a goal implied by the related factor you list with this diagnosis), then wouldn't Deficient Knowledge, Pain control methods R/T lack of knowledge be a better diagnosis to use?

There are two diagnoses for sleep problems: Sleep Deprivation and Disturbed Sleep Pattern (sometimes listed as Insomnia). Whether you use either depends on what the patient's symptoms are. Because fatigue is a symptom here, Sleep Deprivation is probably more appropriate to use. The related factor would be "headache". Sleep Deprivation R/T headaches AEB fatigue.

How did I know that you would respond, Daytonite?Thanks! :bow:

Its for a health history paper that I am writing, we had to interview someone & then find Dx.. Its easy enough but kinda tricky because this is the first time I've actually had to write my own Dx!..

After writing my post I went back to my paper and this is what I put:

-Acute Pain R/T lack of knowledge of pain control techniques or methods to prevent headaches AEB reported headache that measures a 2/5 on the Wong-Baker Faces Pain Scale.

(When I looked up "headache" in my Nursing Diagnosis Handbook by Ackley, "Acute Pain" is where it took me to. And then it had the pain scale, which I figured I would use... but do I have to use that for headaches?...Head pain can fluctate so I dunno if I'm going to keep that Dx...I like yours better.:D)

-Sleep Deprivation R/T sustained inadequate sleep hygiene AEB fatigue.

(...Can I write "...R/T sustained inadequate sleep hygiene and headaches AEB...."? That way it incorporates the headache in there also...)

  • Experts

well, i'm just sitting here flabbergasted! i assume these are your first attempts at diagnosing. you did well.

the more you work with the different diagnoses, the more you begin to realize that there is sometimes some tweaking room in how you classify a problem. a lot of times the etiology of a problem can be a big determining factor in the diagnosis choice you make. if you read the definitions of these diagnoses, you will also get an idea of what the intention of a problem is supposed to be as well. the nursing diagnosis is actually a shorthand label and can be misleading.

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