I'm stuck on this care plan.

sddlnscp · Nov 19, 2007

What about something like Knowledge Deficit r/t lack of patient understanding regarding type II DM aeb patient unable to control blood glucose within a therapeutic range and asking questions regarding DM.

That doesn't sound quite right either, but my brain is fuzzy after clinicals yesterday (which were great btw, just busy) and doing tons of work today!!! :) Hopefully it helps you to at least get on the right track. I'm sure someone else with more input will come along soon.

vwdeano · Nov 19, 2007

DM has many presentations in the psychiatric community and those diagnosed are famous for inconsistent to no compliance. This may be a hinge for you to use on presenting your plan, certainly challenging, but it will fit!

D

Registered Psychiatric Nursing Student.

Daytonite, BSN, RN · Nov 20, 2007

studentnurseabby. . .the nursing diagnosis can be deficient knowledge, type ii diabetes r/t......but......i can't go any further in helping you because you haven't presented any of your assessment data. you can't just pull a nursing diagnosis out of thin air for a patient. every diagnosis is based upon the assessment data you collected. you need to use a nursing diagnosis reference book to help you with the wording. it will have the related factors and defining characteristics listed to help you out. if you don't have a book you can use these webpages which have that information to help you:

[color=#3366ff]deficient knowledge (specify)

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=34

this is how you choose nursing diagnoses:

(from page 4 of

nursing diagnosis handbook: a guide to planning care

, 7th edition, by betty j. ackley and gail b. ladwig)

"when the assessment is complete, identify common patterns/symptoms of response to actual or potential health problems and select an appropriate nursing diagnosis label using critical thinking skills.

highlight or underline the relevant symptoms.
make a short list of the symptoms.
cluster similar symptoms.
analyze/interpret the symptoms.
select a nursing diagnosis label that fits with the appropriate related factors and defining characteristics.

the process of identifying significant symptoms, clustering or grouping them into logical patterns, and then choosing an appropriate nursing diagnosis involves diagnostic reasoning (critical thinking) skills that must be learned in the process of becoming a nurse."

StudentNurseAbby · Nov 20, 2007

Thanks for your help. I was using my book prior to asking this question but I think I was so exhausted I was missing what was right in front of me. I ended up using:

Ineffective health maintenance R/T deficient knowledge regarding care of diabetic condition AEB a demostrated lack of knowledge regarding diabetic health practices such as dietary modifications and blood glucose monitoring.

Now, it seems long too me. Should I re-word the AEB? Maybe say "AEB noncompliance with dietary modifications and inconsistent blood glucose monitoring?

Daytonite, BSN, RN · Nov 21, 2007

you're talking about three different nursing diagnostic labels and i've yet to hear you say anything about this patient and what is going on with them. i can't tell you if this diagnostic statement is ok for this patient or not because i don't know one thing about the patient or anything about what you found in their assessment. there are problems with it's construction, however, which i address below. what did you find during your assessment that lead you to ineffective health maintenance (definition: the inability to identify, manage, and/or seek out help to maintain health) ([color=#3366ff]ineffective health maintenance) which would indicate that the patient already has the knowledge they need, but they are just not able to put it into practice for the listed reasons. deficient knowledge is not an appropriate related factor that nanda lists with this diagnosis. if the patient is indeed lacking in knowing what foods to eat to keep their blood sugar controlled and doesn't know how to do their blood glucose monitoring then you have a knowledge deficit (definition: absence of deficiency of cognitive information related to a specific topic.) [[color=#3366ff]deficient knowledge (specify)]

noncompliance (http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=36) is an attitude and choice the patient makes to not follow a plan of care after agreeing to do so combined with the patient knowing what it is they are supposed to do. its definition is behavior of person and/or caregiver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (and/or family and/or community) and healthcare professional. in the presence of an agreed-on, health-promoting or therapeutic plan, person's or caregiver's behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes. it is also inappropriate to use that particular word (noncompliance) as a defining characteristic. you would need to word the patient's symptoms differently.

please be careful when you are making a decision about placing a diagnosis on someone. we have the nanda taxonomy that you should be referring to in helping to diagnose correctly. you should be using as current a care plan or nursing diagnosis book as you can get your hands on to refer to the nanda references on this. you particularly want to carefully read the definition of any diagnosis you are going to use to see if it fits your patient's circumstances and then review the listings of related factors (etiologies) and defining characteristics (symptoms) to see if they also fit your patient's circumstances. if they don't, then you're in the wrong diagnosis and need to look elsewhere. you can't just take shots in the dark and hope you've chosen correctly which is what it sounds like you are doing. i've given you weblinks to online nursing diagnosis pages from the ackley/ladwig and gulanick/myers nursing diagnosis books to help you out in the event that you don't have a care plan or nursing diagnosis book so you can see with your own eyes what the nanda taxonomy has to say about the three diagnoses you are wanting to use. the nanda information is at the very top of each of the three webpages. please read it carefully to help you determine if your patient fits one of these categories. then, use the related factors and defining characteristics information to help you with the wording of your final diagnostic statement. it should also help you to determine if your patient has any of the symptoms that are listed with these diagnoses. you just may have missed something in your assessment of the patient!

give this another try.

DermNP2Be · Nov 21, 2007

StudentNurseAbby- Daytonite is the best person on this site to help you (I think so from many of her posts that I've read), but you've gotta make sure to give her enough info- she's always willing to help. To even come up with a proper diagnoses, you have to understand the process of doing so and why it is set up that way, then you will know what info you're even looking for. You say that you were to come up with a nursing diagnoses on knowledge deficit, but the 1st words of your diagnoses was ineffective health maintenance and your r/t was deficient knowledge. As Daytonite said, deficient knowledge is not an r/t. If you were to come up with a diagnoses of deficient knowledge, then the 1st part of the diagnoses is already done for you. It would start: Deficient knowledge (specify disease process of diabetes) r/t... Now, r/t shows a patterned relationship w/the diagnoses and are usually NANDA specific. Ask yourself, "What is the reason for their problem (deficient knowledge)"? Could it be that they misinterpreted the info explained to them (information misinterpretation)? Could it be that they are not able to mentally process the information (cognitive limitation)? Could it be that they just don't care to learn the information (lack of interest in learning)? Could it be that they can't remember the information explained to them (lack of recall)? These are your r/t's! Now, the end of the nursing diagnoses is the AEB (as exhibited by)- which is exactly what it is- "what is the patient doing to make you think he/she has a knowledge deficit in this area"? Are they not following through with instructions given to them (inaccurate follow through of instruction)? Do they act inappropriately- hostile, agitated- (inappropriate behaviors)? Or did they just plain tell you, "I don't understand this" (verbalization of the problem)? Answer these questions and you have yourself a diagnoses. For example:

Patient given instructions on controlling his/her Type II DM, yet fails to perform home blood glucose monitoring because they state that they "thought they were following the instructions correctly and now they are just plain confused about how/when to do it".

So the nursing diagnoses would be:

"Deficient knowledge of technique/timing of home blood glucose monitoring r/t information misinterpretation AEB patient verbalization of confusion regarding home blood glucose monitoring."

See? When you know the info you're looking for it's much easier. Hopefully Daytonite will correct me if I'm incorrect, but that's how I've been taught to do it (I've gotten perfect grades on care plans so far). I don't know what book you're using, but Nursing Diagnoses Handbook: An Evidence-Based Guide to Planning Care by Ackley is what was included in our $1000 nursing book package. I like it because in the beginning of the book, you can look up specific diseases/ailments and it gives you a list of ND's for that disease (but I usually use one or two besides what's listed), in the back of the book is an alphabetical list of all the NANDA diagnoses, and each diagnoses within the book has the r/t factors for that disease, several intervententions, suggested client outcomes, and defining characteristics which usually are the signs patients exhibit that relates to your diagnoses (the 1st part)- which are ding!- AEB's (as exhibited by's). Another book that I find helpful is the All-in-One Care Planning Resource by Swearingen that covers Med-Surg, Peds, Maternity & Psych. Hope this helps!

Cosper123 · Nov 22, 2007

Read Daytonite's posts as if they were pages from a bible for nursing.

They are often times overwhelming and confusing to a student but this poster has helped me to think of things in a way that I never could before. Just tackle that last post in sections if you have to, but take the time to really listen to what is being said there.

Also check out the critical thinking flowsheet in their sig, it's a very useful learning tool.

StudentNurseAbby · Nov 22, 2007

First of all, I feel like I'm being scolded.

Second of all, I got this...

Ineffective health maintenance R/T deficient knowledge regarding care of diabetic condition

directly from the Nursing Diagnosis Handbook.

The r/t factor they list in the Ackley book is deficient knowledge. So, I'm feeling sort of misquided at this point.

Maybe it's best for me to ask my instructor about it, she's grading it...hopefully she can steer me in the right direction.

Thanks for your help.:)

Daytonite, BSN, RN · Nov 22, 2007

Forgive me if you felt I was scolding you. I am trying to teach you what I know. You were looking for information on how to word your diagnosis. I'm saying that the wording for your diagnosis pretty much comes from the NANDA taxonomy. The only part of it that doesn't are your patient's symptoms (the part the follows the AEB section of the diagnostic statement) which you need to word to fit what you found during your patient's assessment. You didn't, however, provide any of that information. Then, you posted a diagnosis you got from a care plan book. If you think that fits your patient's circumstances after your did your assessment, read the description of the diagnosis and looked over the related factors and defining characteristics--then use it. You are the only one who saw this patient and knows them better than any of us. I am more concerned that you understand the process of how to get to the correct diagnosis. Anything I ever post is only meant to be a suggestion. I would always expect the student to make the final decision as to what to finally do. It's your grade not mine. You know what your instructors expect of you; I don't. What I do know is the NANDA taxonomy and how the nursing process works and I wasn't sure that you were clear on that.

DermNP2Be · Nov 23, 2007

I, too, am sorry if you felt that I was included in the scolding. I just get so excited because nursing is exactly what I want to do and I don't have much help besides the postings that I read here that have assisted me immensely. I in no way meant to belittle or scold you; I was just so excited to share something that finally came together in my head that I could assist someone else in need. You have the right idea though- ask your prof because he/she is the one that will be grading it. Good luck.