I need an appropriate nursing diagnosis!

[ashd]

hello everyone, i'm a second semester nursing student and just discovered this great site!

anyways, i need help finding a good diagnosis for a patient that i had which i am doing a care plan on.

basically this pt came in because of chest pain, medical dx: CHF risk of MI. this pt was actually very well and was awaiting to be discharged that day the only thing that this pt was waiting for was their external defibrillator to come in.

hx: pt had a triple bypass 1 month ago and came back because of chest pains, they also developed edema around their feet and ankles. at my time of assessment their vitals where within a good range, the edema was going down and had no pitting. they also had a stage I ulcer that was healing. this pt is able to walk and is Alert and oriented x4. pt also has a history of smoking.

I had a diagnosis for readiness for enhanced therapeutic regiment management, because there was an order for diabetic teaching since after their surgery their blood sugar was, "going out of control"

this pt and spouse are both diabetics and were willing to learn more and how to control it.

my teacher questioned that diagnosis and suggested thinking about doing something on end stage cardiac disease, since they were waiting for their defibrillator and unexpected outcomes.

thanks for the help!

[Miami NightNurse]

If they are waiting for an AICD most likely they have Cardiomyopathy and a low ejection fraction, which means they would have a tendency to go into congestive heart failure so you'd have breathing problems. Thenif they are placing an AICD you always have risk for infection post surgery. And if they are still smoking that would be a big issue

Oh you wrote external defibrillator. Do you mean a Life Vest Defibrillator?

[rotteluvr31, ADN, RN]

how about something r/t impaired circulation? or knowledge deficit?

[leslie :-D]

i'd be looking along the lines of co, gas exchange/ventilation/breathing patterns, activity...

leslie

[manofcare]

Decreased cardiac output, fluid volume excess, R/F impaired gas exchange, activity intolerance

[Daytonite, BSN, RN]

hi, ashd, and welcome to allnurses! :welcome:

diagnosing is always based upon the symptoms that you find. not upon the medical diagnosis or condition that the patient has. nursing diagnoses, unlike medical diagnoses, can also be based upon the patient's response to their medical condition. in your post you listed the following symptoms and patient responses to their conditions:

• chest pain
  
• edema around their feet and ankles
  
• stage i ulcer that was healing (where is this ulcer and what else can you describe about it?)
  
• smokes (what does the patient have to szys about this?)
  
• willing to learn more about diabetes and how to control it
  
• waiting for their external defibrillator to come in and needs instruction in how to use it

it is from this list of symptoms/responses that you determine your patient's problems (nursing diagnoses)--not from their medical diagnoses. every nursing diagnosis has a defined list of symptoms called defining characteristics. you can find them listed in the nanda taxonomy. many currently published care plan books include the nanda taxonomy that goes with each nursing diagnosis which you should get accustomed to looking at so you verify that you are diagnosing correctly.

from the above list i would assign the following nursing diagnoses to this patient:

• acute pain r/t cardiac arrhythmias [this is the best reason i can think of for the patient's chest pain, but this is your patient and if you know some different etiology of this chest pain it needs to go here] aeb chest pain
  
• decreased cardiac output r/t altered contractility aeb edema in feet and ankles
  
• impaired skin integrity r/t (impaired circulation? impaired metabolic state? changes in fluid status?) aeb stage i ulcer (and it's description)
  
• knowledge deficit (coronary artery disease, diabetes, use of external defibrillator) r/t lack of factual information aeb verbalized statements by patient and spouse of willingness to learn more about heart disease and diabetes as well as how to control it, and need for instruction in how to use the external defibrillator before being discharged
  
• there are two ways you can address this issue of smoking and it depends on whether or not the patient is agreeable to a plan of action:
  • ineffective health maintenance r/t denial of the effects of smoking aeb continued smoking behavior
    
  • readiness for enhanced knowledge of smoking cessation r/t interest in improving health aeb verbalized statements of interest in smoking cessation program

your goals and nursing interventions for each nursing diagnosis are all based upon the symptoms that are listed under that diagnosis. your goals are the results you expect to occur once your nursing interventions are performed.

as you can see, what is important in your care plan is that list of patient symptoms and/or their responses to their condition(s). their medical diseases become important to you because you need to know their pathophysiology to help you understand the symptoms they are having. you also need to know how the doctor is going to treat the disease (meds, treatments, tests) in order to anticipate his orders and answer the patient's questions. however, our nursing interventions are aimed at the symptoms and responses the patient is having.

i write about care planning and choosing nursing diagnoses all the time. you can read more about what i have to say on this thread:

• https://allnurses.com/forums/f50/help-care-plans-286986.html - assistance - help with care plans