help with psychosocial nursing diagnoses

[namita]

hello every one,

its urgent as my care plan is due this monday.

I am having problem with psychosocial diagnosis. The patient has DepressiveDisorder , reported suicide ideation and multiple plan to kill; also has Polysubstance dependence and reported that has been taking opiate and benzodiazepine more than prescribed "to feel better". also has Osteogenesis Imperfecta a congenital connective tissue disorder of bone also called "brittle bone disease' and has to go 21 surgeries in hip and legs. I came up with these diagnoses:

Psychosocial:

1)risk for self directed violence r/t suicide ideation and plan aeb pateint verbalizing multiple plans to "kill" himself

( My instructor told us to use r/t and AEB for 'risk for' diagnosis too. STRANGE isn't it)

2) ineffective coping r/t inadequate coping skills and inadequate ability to cope with stress aeb substance dependence and patient stating "I can't take it anymore"

For above diagnosis can I use "situational crisis" as related factor?

3)social isolation r/t ??? aeb not participating in group activities and eating alone and not going in cafetaria, and homebound,

Can I use fear of rejection coz patient gets panic attack whenever he has to go out of his house so he stays home bound and states "I can't go out side and have any fun." NEED HELP

4)chronic Low self esteem r/t negative view of self aeb patient stating "I am tired of always feeling bad."

Phyical diagnosis;

1)Impaired physical immobility r/t:uhoh3: musculoskeletol impairement in lower extremities secondary to genetic bone disorder(not allowed to use medical diagnosis of 'osteogenesis imperfecta')aeb low muscle tone in extremities and inability to ambulate effectively without crutches

NEED HELP in related factor for above diagnosis

2) risk Risk for Imbalanced Nutrition: Less than Body Requirements r/t physiologic response to stress AEB reported loss of appetite by patient

[RNTutor, BSN, RN]

2) I would say that situational crisis can definitely be a r/t factor, especially if the crisis exceeds the pt's current coping strategies.

3) I might identify the r/t as "increased anxiety in social situations" or unfamiliar surroundings, or even r/t fear of having a panic attack in public. It doesn't really sound like fear of rejection to me.

Physical: 1) Personally, I think it's a little silly not to use medical dx in an obvious case like this, but you gotta do what the teacher wants...I think that sounds like a fine description. If you wanted, you could probably even leave off the secondary to genetic part. Or you could rephrase to describe the actual presentation of the impairment, or his hx...like "r/t hx of frequent leg fractures"

Hope those ideas help a little.

[namita]

Thanks a lot RN Tutor for your help.