Help with a nursing diagnosis for a smoker

[lwhitten]

Needing a good diagnosis for a smoker, risk prone behavior wasn't what she was looking for:/ Ashby ideas?! Thanks ?

[Live.&.Learn]

Risk for decreased cardiac tissue perfusion r/t lack of knowledge of modifiable risk factors (e.g., smoking, sedentary lifestyle, obesity)

Ineffective peripheral tissue perfusion r/t Deficient knowledge of aggravating factors (e.g., smoking, sedentary lifestyle, trauma, obesity, salt intake, immobility)

Or if there is a desire to quit...

Readiness for enhanced Self Health management

Readiness for enhanced Power

Otherwise need more info on your pt...blood gases? emphysema? anything going on related to the smoking?

[nurseprnRN, BSN, RN]

No, no. No. You have no assessment data here to make a nursing diagnosis. Therefore you cannot make one, and neither can anyone else, even if they mean to be helpful.

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column a, one from column b list out there. Nursing diagnosis does not result from medical diagnosis, period. This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (other disciplines may implement other parts, like radiology, or therapy, or ...) that is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

Yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.

For example, if I admit a 55-year-old with diabetes and heart disease, I recall what I know about dm pathophysiology. I'm pretty sure I will probably see a constellation of nursing diagnoses related to these effects, and I will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. I might find readiness to improve health status, or ineffective coping, or risk for falls, too. These are all things you often see in diabetics who come in with complications (and there are more, and many that an individual patient might have independent of his medical diagnosis).. They are all things that nursing treats independently of medicine, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. But I can't put them in any individual's plan for nursing care until *I* assess for the symptoms that indicate them, the defining characteristics of each.

If you do not have the nanda-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, sids, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... There's a match. If not... Keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with the reference for the professional nurse.

A nursing diagnosis statement translated into regular english goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "Caused by," not something else. In your original diagnosis (which isn't a nursing diagnosis, by the way) you said that altered hepatic function was caused by jaundice, which is, of course, exactly backwards. But since you can't use "Altered hepatic function" because it isn't a nursing diagnosis, we'll skip that.

To make a nursing diagnosis, you must be able to demonstrate at least one "Defining characteristic." defining characteristics for all approved nursing diagnoses are found in the nanda-I 2012-2014 (current edition).

[nurseprnRN, BSN, RN]

Quote

risk for decreased cardiac tissue perfusion r/t lack of knowledge of modifiable risk factors (e.g., smoking, sedentary lifestyle, obesity)

ineffective peripheral tissue perfusion r/t Deficient knowledge of aggravating factors (e.g., smoking, sedentary lifestyle, trauma, obesity, salt intake, immobility)

or if there is a desire to quit...

Readiness for enhanced Self Health management

Readiness for enhanced Power

otherwise need more info on your pt...blood gases? emphysema? anything going on related to the smoking?

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. Decreased blood flow is not caused by a knowledge deficit. Although sometimes I think that knowledge deficit in some folks must be caused by lack of blood flow to the cerebral cortex, I doubt very much that's in the allowed list of defining characteristics. I don't see "decreased cardiac tissue perfusion" in the nursing dx list either-- that's a medical diagnosis.

Let's try this again, from a nursing standpoint.

[Stephalump]

What about Risk Prone Health Behavior? I'll let you come up with your own R/T, but that one seems safe and relevant enough without any assessment data :)

Edit: Ah, I didn't see your last part about her not accepting it! Lame.

What about impaired gas exchange? Knowledge deficit? Risk for activity intolerance? Risk for decreased cardiac tissue perfusion?

[nurseprnRN, BSN, RN]

Stephalump said:

What about impaired gas exchange? Knowledge deficit? Risk for activity intolerance? Risk for decreased cardiac tissue perfusion?

What about them?

Again, the place to start is not with the diagnosis, it's with the assessment data. I don't see anything from the OP that indicates that there is any.

[Stephalump]

Quote

What about them?

Again, the place to start is not with the diagnosis, it's with the assessment data. I don't see anything from the OP that indicates that there is any.

The fact that the patient is a smoker is assessment data, is it not?

It would think that would be enough information for a "risk for" diagnoses. Maybe not a strong diagnoses, but I don't know how a professor who simply asks for a diagnoses for a smoker could expect anything more.

[Live.&.Learn]

"Risk for decreased cardiac tissue perfusion"(nanda 00200), and these were simply the r/t factors from the book. Our nursing Dx are formatted like this...nursing dx (from nanda) r/t (from book) AEB (s/s etc from pt, labs, chart, et...defining characteristics). Obviously, this isn't my pt and I could not possibly come up with appropriate nursing Dx, these were just suggestions of what may be accepted by my clinical instructor and to be used as a guide by this student. Simply, "here's a couple of ideas, now look at your pt and see if any of these work".