Impaired tissue integrity ??

[stillinschool2010]

I have a patient who underwent a cesarean section secondary to frank breech presentation. Other than that my patient is relatively healthy. My question is if one of my diagnosis is impaired tissue integrity what is the related to? I had down r/t destruction of skin layers (dermis) but that sounds more like Impaired skin integrity to me. However, that is the one that my professor suggested (with the impaired skin integrity). The related to factor is always the hardest part of my diagnosis and I always end up confused after help from my professors. Does anyone know any tips for picking the related to factors? :imbar

[Bug Out, BSN]

In this case the skin integrity and tissue integrity are very similar...personally I would not use both in the same careplan.

When they did the CS did they only cut the skin? What are all the tissues that were impaired???

When writing ND I would suggest not thinking so hard, it really is as simple as it first looks but we often try to think too much about it.

a ND is Problem+Cause or Origin+S/S (BTW you do not always have to include a S/S)

I don't want to write the ND for you but I would write it along the lines of "Impaired tissue integrity r/t belly being split open like the kangaroo/donkey thing in Star Wars"

[Daytonite, BSN, RN]

there is a very specific difference between impaired tissue integrity and impaired skin integrity.

• impaired tissue integrity is damage to mucous membrane, corneal, integumentary, or subcutaneous tissues. (page 323, nanda international nursing diagnoses: definitions and classifications 2009-2011)
  
• impaired skin integrity is altered epidermis or dermis. (page 320, nanda international nursing diagnoses: definitions and classifications 2009-2011)
  

impaired tissue integrity is the correct diagnosis since the incision for the c-section would have gone through the subcutaneous tissue. the etiology (cause) of this is surgical intervention.

r/t destruction of skin layers (dermis)

rather than being an etiology, or cause, this is merely a restatement of the diagnosis in different words.

- - - - - - - - - - - - - - -

the construction of the 3-part diagnostic statement follows this format:

p (problem) - e (etiology) - s (symptoms)

• problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
  
• etiology - also called the related factor by nanda. this is what is causing the problem. it is the reason the problem exists and reasons can be many and varied. ask yourself "why did this happen?" or "how did this problem come about?" "what caused this to become a problem in the first place?" and dig deep. consider the medical diagnosis, the medical treatments that were ordered and the patient's ability to perform their adls. pathophysiologies need to be examined to find these etiologies if they are of a physiologic origin. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this.
  
• symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.