Help Please? "Risk for" ND is bothering me...

[Sleepdeprivedstudent]

My care plan is due tomorrow and I am really hung up on her ND. She was a postpartum patient that had some excessive bleeding (blood clots expelled by the doc the next morning after C-section.) So, my primary diagnosis would be that. But I am not sure what to choose for a ND? I have chosen right now "Risk for Deficient Fluid Volume" because I could not say for sure that she had Deficient Fluid volume. There were no signs and symptoms (labs to indicate, hypotension, etc.). I know that actual diagnosis should come before risk for, but in this case, should I make a risk for #1? Risk for Infection is another I thought of. Am I missing an actual diagnosis?? Do you think it is acceptable to put a "risk for" before 3 other actual diagnosis'? Thanks for any input!

Erin

[Daytonite, BSN, RN]

This lady had a C-section, you said. How come you aren't using Impaired Tissue Integrity for her incision? Where are you going to put all the nursing interventions for the wound care?

[Sleepdeprivedstudent]

That is one of the 4 that I chose. We spent alot of time with the bleeding though. That is why I am making it the priority.

[celclt]

is that the top priority tho- the bleeding was intermittant? only that incident? - wound care is ongoing...hth

[APBT mom, LPN, RN]

What was her H&H after delivery and after expelling the blood clots? If shes anemic from the delivery then you could use a dx for that a relate it to her bleeding.

[Daytonite, BSN, RN]

ok, i re-read your original post. you cannot start deciding on any nursing diagnoses until you have done a thorough assessment and developed a list of the patient's symptoms (in nanda language: defining characteristics). for any care plan, the nursing diagnoses, goals and nursing interventions are based entirely on these symptoms. without them, you might as well start grabbing at straws which is what i think you might be doing. this may be the reason you are having a problem coming up with diagnoses for this patient.

the nursing process is a problem solving process and a care plan is merely the written documentation of the problem solving process. you must follow the steps of that process in sequence. as students you should be spending a good deal of time on the assessment part and ferreting out the abnormal symptoms.

1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
   
3. planning (write measurable goals/outcomes and nursing interventions)
   
4. implementation (initiate the care plan)
   
5. evaluation (determine if goals/outcomes have been met)

only after assessment and making a list of abnormal data (symptoms) can you start to figure out what your nursing diagnoses are. all nursing diagnoses have a list of symptoms (defining characteristics) just like every medical diagnosis has a list of symptoms. a patient must have one or more of these defining characteristics of a nursing diagnosis in order to be classified as having that diagnosis. i can't be sure because you haven't given us enough information, but that may be your problem here.

[Sleepdeprivedstudent]

Tampagirl, I did not have any labs because I was with her for such a short period of time, but I am sure her H&H were going to be drawn some time that day, just not while I was there. Celcit, it was not one time, it was ongoing. The bleeding was heavy most of the time I was with her and that was the focus of the treatment (new IV med, doc came in to expell clots, message fundus, pad count, etc.) and that is why I believe it was a priority. Daytonite, I did the whole nursing process (29 pages!), I am not grasping at straws. :icon_roll She was at risk of hemorrhage, that was a priority. I was just not sure if I was missing another ND that fit that better. Thanks for the help everyone!!

Erin

[Daytonite, BSN, RN]

I understand that you are worried about hemorrhage, but if you don't have the facts to support it, then you can't legitimately call it an actual problem. It is, therefore, merely a "Risk for" potential problem.