Help with Nursing Diagnosis

[cupcakesncream16]

I have been working on a nursing diagnosis for DAYS and I am having so much trouble with it. We were assigned a disease (Diabetes Mellitus) and we had to pick 3 NANDA stems

I chose Risk for Injury, Constipation, & Risk for Infection

We then had to write a nursing diagnosis for each

I'm having an extremely hard time doing the related/to portion. This is my first nursing diagnosis ever and I'm so unsure.

1.) Risk for injury r/t nerve damage and loss of sensation

2.) Constipation r/t intestinal nerve damage AEB prolonged period without defecation

3.) Risk for infection r/t altered immune function

I guess my concern is...should these answers be common sense *such as with constipation...decreased water intake* or can they be in depth with the nerve damage even though I have no idea (I researched why diabetes had constipation) because I'm not a doctor and have no additional information. I also made these up with my own words...should I be going out of the book with already written r/t or is it fine to write my own?

I would be willing to exchange some of these NANDA stems if you think it would be easier...such as impaired skin integrity.

If you guys could please help me I would appreciate it so much. I am on the verge of tears because I am so frustrated. No one can help me, I can't find information on writing these anywhere, and my teacher won't email me back.

http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/C-G.html This website has some stuff (risk for injury, risk for infection) under Diabetes Mellitus.

THANK YOU SO MUCH

[SteffersRN87, BSN, RN]

In nursing school, our med/surg instructor required us to present with three nursing diagnoses and appropriate care plans for each patient. The requirement included: one potential problem (risk), one actual problem, and one knowledge deficit/teaching. Diabetes mellitus patients always need teaching (even the well-controlled ones). For example, knowledge deficit related to new diagnosis of diabetes mellitus as evidenced by patient asking many questions or knowledge deficit related to the management of diabetes mellitus as evidenced by chronic hyperglycemia. As far as the potential problem - risk for impaired skin integrity related to chronic hyperglycemia secondary to diabetes mellitus. You could go on for days about potential problems, but that is usually the big one that is stressed. For an actual problem, look at the complication of diabetes mellitus - neuropathy, stroke, renal failure, etc. Neuropathy is a good one to use (plagues a lot of them). So your diagnosis could be - chronic pain related to peripheral neuropathy secondary to diabetes mellitus as evidenced by patient stating their pain level is always a 4/10. Hope this helps!

[dannyc12]

Your diagnosis choices may be making this one a bit harder on yourself than necessary. During your first stab at these, start with the data in the book and go from there.

An assignment to stick nursing diagnoses on a medical diagnosis without any patient data sounds a little strange. I thought the main focus nursing diagnoses was the client responses - the etiology, not the disease.

Did they give you any patient data to use as a basis for the diagnosis? If not, then the assignment is a lot easier when you can pull your own related/risk factors out of your Pocket Guide. You might want to broaden your scope a bit to make the diagnostic statement clearer to you.

A big part of diabetes care is patient education. You might pick some other topics like "Readiness for enhanced nutrition" or "Readiness for enhanced knowledge" for a patient who wants to improve at actively managing their condition.

If a person was newly diagnosed, they could have an "Anxiety" or "Deficient Knowledge" diagnosis.

Look in your pocket guide for Related Factors and you can use those as a base to go hog wild on the etiology.

The more you do these, the easier they get. I notice my classmates who panic over this stuff are the ones who never practice it.

Good luck!

dc

[helper T cell]

Hi,

Risk for Impaired Skin Integrity r/t altered circulation and sensation secondary to peripheral neuropathy and vascular pathology.

You'll need your subjective and objective data

Desired outcomes: Patients skin remains intact. During LOS pt verbalizes and demonstrates accurate knowledge of proper foot care. Its always good to include short term and long term goals

You'll need your interventions and rationale.

Evaluation: have goals been met?

Just the other day i was taking care of a type II uncontrolled diabetic man that was to lose most of his foot due to a foot ulcer that hadn't healed in 2 years. Even though the care plans are a pain they help give you a good knowledge base. Good luck in school.

[TessaMae]

I use the Handbook of Nursing Diagnosis by Carpinito-Moyet and in the back of it there is a section for medical conditions and ND and PC that go along with them. For DM it has the following listed:

the most common is ND: imbalanced nutrition more than body requirements

- risk for injury (could use right from the book r/t lack of awareness of environmental hazards s/t hypoglycemia) then base your careplan off all the info right in the book

- risk for ineffective coping

- risk for noncompliance

- risk for ineffective therapeutic regimen

All of the risk for's would be changed to actual ND if the patient actually had them obviously.

They also have the following Potential complications/collaborative problems

PC: ketoacidosis

PC: hypoglycemia

PC: infection

I don't know if all the books are like this one but they list the major and minor factors associated with each ND and related factors.