How can I explain Pathophysiology?

thor824 · Dec 20, 2014

What do you mean by dehisced?
What surgery did the patient have to the leg?

Your link below to the clinical flow sheet is perfect! Now I get it. Duh. :)

Esme12, ASN, BSN, RN · Dec 21, 2014

Good! Sometimes you just can't see the forest for the trees!

mrsboots87 · Dec 21, 2014

GrnTea, I stand corrected. But my question about using a chronic wound as the primary patho for a careplan, isn't a wound caused by either surgery or trauma, or pressure and such, and the a chronic would come about due to a disease process in the body like a compromised immune system or diabetes or something along those lines. I ask because our instructors have told us that we cannot patho a wound and that we have to patho the disease process behind why the wound is not healing or the surgery that caused the wound if we want to base our careplan around caring for the wound. Sorry if this is jumbled. I'm on my phone and it's acting up so I can't see all the text.

mrsboots87 · Dec 21, 2014

Now that I read the rest of the responses I see why my thought process is different on what a patho can be written on. For our careplans we have to have a primary patho that has to be either a disease process, illness that caused the hospital admit, or surgery done while in the hospital (but surgical pathos have a different format for us). And then we have an integrated patho that we have to integrate the primary pathos with other illnesses and any abnormal labs or wound infections and meds and such. So that is where we would incorporate the wound dehiscence into a patho and explain how everything affects each other.

nurseprnRN, BSN, RN · Dec 21, 2014

Another few thoughts: Did the injury from the accident involve the blood supply (arterial and venous) in the lower leg? Is there an infection in underlying bone?

And what's "a patho"? Is it a named medical diagnosis?

For my money, you have a lot of data to support a presumption for a pathologically nonhealing wound, and a number of good suggestions on how to think about it. One of the cool things about nursing is that while we recognize, understand, and work with medical diagnoses, we look at the patient as a whole (as opposed to a single or set of medical diagnoses). So you could have, shall we say, lousy serum proteins from bad nutritional status that would contribute to increased susceptibility to tissue breakdown and delayed or absent tissue repair in patients with any of a number of medical diagnoses. For example, you could see this in COPD (increased energy requirements with increased work of breathing + poor appetite from hepatomegaly r/t right heart strain + decreased ability to cook/eat), spinal cord injury (decreased testosterone + increased rate of CVD progression + the above + insensate pressure), renal failure (protein wasting + decreased erythropoeitin production / tissue oxygenation), hepatic failure (protein losses in ascites), or elders (all of the above) ... you see the thought process here?

mrsboots87 · Dec 21, 2014

And what's "a patho"? Is it a named medical diagnosis?

Sorry. Our class just calls them pathos.

It's the part of our careplan where we pick the primary disease process/illness or injury/surgery driving the nursing care for the patient and we write a pathophysiology summary for it.

ixchel · Dec 21, 2014

I never imagined in nursing school how complex wounds really are in the real world. This assignment you are working on - SAVE IT. Learn well from it. If this person doesn't have diabetes, you may at some time take a bit of reading time in it, specifically with regards to wound care.

In hospitals, wounds will be an every day part of care, and depending on what floor you are on, HTN, DM, HIV, and all other conditions involving immune response and blood flow will come with them. No one ever has just one "patho", either.

Unfortunately, I imagine you don't have a massive amount of time to invest in this, as nursing school seems to throw giant assignments at you, giving only enough time to cover the bottom line. I really think this could be a huge one, if you let it be. For me, I'd look at each disease present, consider how blood flow and immune response is involved in the delivery of essential nutrients and WBCs, what lab values might be indicative of delay in healing/promotion of infection, and then what can be done to increase healing potential, if anything.

If the ability to heal is poor, or compliance probably not possible, then how can you prevent complications, or know when something has gone terribly wrong, thereby requiring more medical attention down the road?

Goodness, I could geek out on this and write a whole case study. You've got a complex one here!

nurseprnRN, BSN, RN · Dec 21, 2014

Sorry. Our class just calls them pathos.
It's the part of our careplan where we pick the primary disease process/illness or injury/surgery driving the nursing care for the patient and we write a pathophysiology summary for it.

Aha. You do know that nursing diagnoses and the resulting nursing plans of care are not dependent on medical diagnoses, right? You can do what you describe, but then you should never proceed to write a nursing plan of care based solely on ("driven by") a medical diagnosis.

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data.

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. As physicians make medical diagnoses based on evidence, so do nurses make nursing diagnoses based on evidence.

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.

A nursing diagnosis statement translated into regular English goes something like this: "I’m making the nursing diagnosis of/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 many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

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 2015-2017 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2015-2017, 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. CONGRATULATIONS! You made a nursing diagnosis! :anpom: 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.

Two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current NANDA-I 2015-2017 nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

mrsboots87 · Dec 22, 2014

Aha. You do know that nursing diagnoses and the resulting nursing plans of care are not dependent on medical diagnoses, right? You can do what you describe, but then you should never proceed to write a nursing plan of care based solely on ("driven by") a medical diagnosis.

No, def not. We have to write our pathos and integrated patho from medical diagnoses or procedures, but I base my nursing diagnoses off my assessment taking labs and medical diagnoses into account when planning care. It's actually yours and Esme's careplan advice that helped me through my first couple careplans and not "picking" a diagnosis. You guys always give great advice in a no nonsense manner.

nurseprnRN, BSN, RN · Dec 22, 2014

I am sure I can speak for my friend and colleague Esme in thanking you for that. We do our best.

:thankya: :thankya:

nurseprnRN, BSN, RN · Dec 25, 2014

Another thing: There are plenty of very important nursing diagnoses that have nothing whatsoever with being "driven" by a patient's given medical diagnosis. How would you deal with the nursing diagnosis of spiritual distress (A state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being)? This could pre-date the medical diagnosis or develop while in the hospital or other care setting; a savvy nurse might uncover it, and although it could quite possibly have nothing whatsoever to do with the medical diagnosis, it cries out for nursing care.

This is one more reason why it makes Esme and me crazy when students are taught to think about medical diagnosis first, or as a rationale for everything else they look at. It's so incomplete and negates the value of nursing its own self.