Help!! I am stuck on my psychosocial care plan for a dementia patient!

[olchrustyone]

I have been racking my brain and I can not come up with a psychosocial nursing diagnosis for my care plan. My patient is in the beginning stages of vascular dementia. She has pretty significant short term memory loss. Her chart says that she has bouts of depression, but I have not been around her during those times. She always seems happy and accepts her condition. One of my instructors suggested interrupted family process because her family does not come to see her hardly anymore and it bothers her. I don't know how to tie that all in with the NANDA book because it gives me interventions for the family and not the patient. I have never even met her family. I'm just lost. She has a history of insomnia, depression, and anxiety but since I have been at the nursing home she has not shown any signs of these disorders to my knowledge.

[nurseprnRN, BSN, RN]

You can tell your instructor you'd like to discuss the concept that it is inappropriate to label a patient with a nursing diagnosis for which you have not been able to identify a single defining feature in your assessment. Sit back and shut up and see what she says to that.

However one thing you said got my attention. The NANDA-I 2012-2014 doesn't have one single line in it about interventions at all in any page about any nursing diagnosis. So what do you mean that your "NANDA book" gives you interventions (of any kind)? Get the real, the ONLY NANDA-I book and see what defining characteristics are for various coping, spiritual, and other domains' diagnoses for THIS patient, and then see what interventions YOU can come up with. You can't make up nursing diagnoses, but you can develop ways to mitigate risks or address causative (related to) factors.

[olchrustyone]

We are using the Nursing Diagnosis Handbook by Ackley and it does have interventions and rationales in it.

[Esme12, ASN, BSN, RN]

but the only book that gives them "all" is NANDA I....While I see GrnTea's point....I would not suggest you challenge your instructor that they are inappropriate. Unfortunately, some instructors take a liberal interpretation of NANDA I ....but you need to do what the school asks....In use Ackley as well. In dealing with the family you help the patient.....I would also think about....

Chronic Confusion: as defined by NANDA...irreversible, long-standing, and/or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli; decreased capacity for intellectual thought processes; and manifested by disturbances of memory, orientation, and behavior

Impaired Memory: as defined as.....Inability to remember or recall bits of information or behavioral skills; impaired memory may be attributed to pathophysiological or situational causes that are either temporary or permanent

Compromised family Coping : A usually supportive primary person (family member, significant other, or close friend) provides insufficient, ineffective, or compromised support, comfort, assistance, or encouragement that may be needed by the client to manage or master adaptive tasks related to his or her health challenge