Help with nursing dx re: surgery pt

[BeesMama]

Ok - so I have to do two nursing diagnosis for the two surgeries that I observed. Here is the catch, only one can be a "risk". I had a patient go for a partial nephrectomy and the other patient had a lymph node excision and lumpectomy. I can think of most of the risks - infection, bleeding, self-image, etc. But for the life of me, I cannot come up with one that isn't a risk. Since my objective that day was to observe surgery, I didn't have the chance to assess the patient (other than quickly in the surgery room - and it was from 4 feet away!). So I have no real "evidence" to support many dxs.

I was trying to do altered urinary elimination r/t nephrectomy, presence of Foley catheter and surgical procedure AEB??? He hasn't had a problem yet because I left before the procedure was even finished. I suppose I could assume he had the issues after the fact, but again, it would be purely assuming.

I thought I could do disturbed body image - but like with the above - I don't have evidence to support a dx.

And we aren't allowed to use pain - so that is out too.

I'm at a loss. Any advice or guidance would be greatly appreciated!

[RescueNinjaKy]

How's their airway especially the lymph node excision. Usually they need to do some deep breathing exercise post op.

[BeesMama]

It was axillary - so near the arm pit. Her airway wasn't compromised during surgery. And I can't think of any evidence for that either.

I think I could do anxiety - but I just did that on a previous assignment and she hates seeing the same thing more than once (she is VERY picky)

[Esme12, ASN, BSN, RN]

What about the care of the patient intra operative? What are you concerns?

Nursing activities in the intraoperative period center on patient safety, facilitation of the procedure, prevention of infection, and

satisfactory physiologic response to anesthesia and

surgical intervention.

http://samples.jbpub.com/9781449688066/87625_CH01_Pass2.pdf

http://nursing.uchc.edu/unit_manuals/perioperative/or/docs/Perioperative%20Plan%20of%20Care.pdf

http://www.elsevierhealth.com/media/us/samplechapters/9780702027574/9780702027574.pdf

nursing care plan for the perioperative patient 2003

NURSING CARE OF THE PERIOPERATIVE CLIENT

[RunBabyRN]

I know that in postpartum, we use altered urinary elimination anytime there's someone with a Foley. However, it's can't be "r/t nephrectomy", as that is a medical procedure. Look at your nursing diagnosis manual for some guidance on better wording.

[nurseprnRN, BSN, RN]

You don't "do" a nursing diagnosis, and you don't "choose" one. You MAKE a diagnosis in the same way any other professional does-- you look at the evidence. I hear you that your limited exposure to the patient during your observation time makes it hard to do that. You could have info from the chart about other matters; you could also tell your instructor that if you observed thus-and-such, you would make the XYZ nursing diagnosis, and if you observed this-else, you would diagnose ABC nursing diagnosis. Do not limit yourself to things that are strictly related to the medical diagnosis, though-- think more broadly about the patient experience. See how she feels about that.

However, in response to

it's can't be "r/t nephrectomy", as that is a medical procedure.

, it is perfectly acceptable to use a medical diagnosis as a related/causative factor IF it is an approved one for the nursing diagnosis you make-- if you read your NANDA-I 2012-2014 you will find bazillions of nursing diagnoses that do this. For example, just flipping my book open randomly, here's "Chronic confusion," p. 265, which includes as related/causative factors a number of medical diagnoses -- Alzheimer's, CVA, head injury, Korsakoff's psychosis, and multi-infarct dementia. Here's "Risk for constipation," (p. 206) with risk factors that include (among many others) enlarged prostate, rectocele, tumors, and depression, all medical diagnoses. "Pain" (p.478) can be r/t a surgical procedure or medical diagnosis like sickle cell anemia, for sure.

[Lev, MSN, RN, NP]

How were the labs? Was the patient(s) NPO? What's the diet? Maybe you can do something related to Nutrition. Why did the patient get the nephrostomy? Maybe you can create a diagnosis based on that.. Was there a lot of blood loss when they placed the nephrostomy tube?