Nursing Students General Students
Published Mar 15, 2007
futurenurse85
130 Posts
hello! what are some nursing interventions for the diagnosis of "altered role performance r/t vision loss and bilateral amputation secondary to chronic disease AEB patient dependent with ADLs and inability to care for others"?
does this diagnosis sound okay? my patient is blind in both eyes, has uncontrolled DM, ESRD, left below the knee amputation, and all toes on right foot are amputated. is altered role performance an appropriate nursing diagnosis for this patient? he also has a history of suicide attempt, so i was thinking maybe using "spiritual distress" or "hopelessness." i would greatly appreciate any input! thank you so much and have a wonderful day!!
Daytonite, BSN, RN
1 Article; 14,604 Posts
the definition of ineffective role performance is: patterns of behavior and self-expression that do not match the environmental context, norms, and expectations. some of the defining characteristics listed with this nursing diagnosis are change in capacity to resume role, change in self-perception of role, change in usual patterns of responsibility, depression, inadequate adaptation to change, inadequate coping, inadequate motivation, powerlessness, inadequate role competency, role overload and role strain which might fit your patient based on what you said about him. the related factors are broken down into those of knowledge (inadequate role model, inadequate role preparation, lack of education, lack of role model, unrealistic role expectations), physiological (body image alteration, cognitive deficits, depression, fatigue, low self-esteem, mental illness, neurological defects, pain, physical illness, substance abuse), and social (conflict, developmental level, domestic violence, inadequate role socialization, inadequate support system, inappropriate linkage with the healthcare system, job schedule demands, lack of resources, lack of rewards, low socioeconomic status, stress, young age) [nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international page 180-181.] so, it sounds like your diagnostic statement would need to be re-worded to say ineffective role performance r/t physical health aeb depression and inadequate coping ??? is that where you are trying to go with this diagnosis?
for blindness, you could use disturbed sensory perception: visual. with esrd, diabetes and a amputation he obviously has a tissue perfusion problem (ineffective tissue perfusion: renal and peripheral). you should also consider these: impaired physical mobility, ineffective coping, or risk for suicide. it sounds like this patient has a lot of physiological problems and a history to self-inflict harm that needs to be addressed. this tendency toward depression and suicide is not all that uncommon in a long-term chronic disease like esrd. take away the dm and the esrd and the suicide probably wouldn't be an issue unless he has other mental health issues.
PLEASE tell me how these nursing diagnoses sound..are they relevant to my patient you think?
-ineffective coping r/t vision loss and amputation secondary to chronic disease process AEB patient statement "i have no value and feel like a burden to my wife."
-impaired physical mobility r/t vision loss and amputation AEB complete dependence w/ ambulation."
-ineffective tissue perfusion r/t chronic disease process AEB weak tibial pulse, decreased urine output, and elevated BUN and creatinine lab value.
(i got the BUN/creatinine from my care plan book..but how is it an AEB for ineffective tissue perfusion?..i know that probably is a stupid question)
-disturbed sensory perception, visual r/t chronic disease process AEB bilateral vision loss.
-powerlessness r/t chronic illness, dependence with ADLs and inability to perform role responsibilities AEB patient statement "i have no value and feel like a burden to my wife."
-risk for impaired skin integrity r/t altered physical mobility, poor circulation and altered sensation secondary to chronic disease process.
(i forgot to mention, he also has peripheral vascular disease)
if anyone could offer any suggestions or input i would really really appreciate it! thank you!!!
futurenurse85. . .is this your first time at putting together a care plan and choosing nursing diagnoses? what reference, or guidelines are you using to write your nursing diagnostic statements? the reason i am asking is because the ones you are suggesting in both of your posts have no rationale to them. the nursing diagnostic statement clearly flows so that the
these elements are all laid out for you in a book of nursing diagnoses or one of the current care plan books. most of them follow the nanda-i guidelines.
ineffective coping r/t vision loss and amputation secondary to chronic disease process aeb patient statement "i have no value and feel like a burden to my wife."
and, this is what the final result looks like: situational low self-esteem due to long term chronic disease r/t functional impairment secondary to esrd and dm aeb patient statement that "i have no value and feel like a burden to my wife". if you read this, it has a flow and a rationale to it. his statements are a reflection of his low self-esteem and the reason is because of his functional impairment due to his chronic illnesses. make sense? http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=44 [color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_061.php
impaired physical mobility r/t vision loss and amputation aeb complete dependence w/ ambulation."
and, the final result will look something like this: impaired physical mobility r/t (type of) amputation and depressive mood secondary to dm and esrd aeb [symptoms] http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=35 [color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_047.php
ineffective tissue perfusion r/t chronic disease process aeb weak tibial pulse, decreased urine output, and elevated bun and creatinine lab value(i got the bun/creatinine from my care plan book..but how is it an aeb for ineffective tissue perfusion?..i know that probably is a stupid question).
(i got the bun/creatinine from my care plan book..but how is it an aeb for ineffective tissue perfusion?..i know that probably is a stupid question).
if you look carefully at your care plan book for ineffective tissue perfusion, it breaks this particular diagnosis down into categories of renal, cerebral, cardiopulmonary, gastrointestinal and peripheral systems. this goes to the underlying pathophysiology of your patient's disease processes. with impaired peripheral perfusion, yes, you are going to see a weak tibial pulse. with impaired renal perfusion you are going to have elevated blood pressures, elevated buns and creatinines and no urine output because the kidneys are in failure. in this patient's case it is all likely due to the atherosclerotic changes in the blood vessels secondary to his diabetes. this is common in diabetics who develop esrd. but, again, in your nursing diagnostic statement you've got to tie your symptoms to the problem which is an interruption of blood flow in both cases--that's what atherosclerosis does. so:
your nursing diagnosis statement will look like this: ineffective tissue perfusion: peripheral and renal r/t interruption of blood flow secondary to dm aeb weak tibial pulse, [decreased or no?, you need to specify] urine output, elevated bun and elevated creatinine. http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=55 [color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_072.php
disturbed sensory perception, visual r/t chronic disease process aeb bilateral vision loss.
powerlessness r/t chronic illness, dependence with adls and inability to perform role responsibilities aeb patient statement "i have no value and feel like a burden to my wife."
risk for impaired skin integrity r/t altered physical mobility, poor circulation and altered sensation secondary to chronic disease process.
that leaves you with four nursing diagnoses by my count. they should be sequenced in priority like this:
IrishIzCPNP, MSN, RN, APRN, NP
1,344 Posts
I wanted to throw in here that I think it is EXTREMELY important that people own a copy of either the current NANDA diagnoses book or another one that is available in order to understand the definitions.
My school did not require one and when it was brought to their attention that the care plan book we have is crap and there are better books I was told to put it on the eval. Apparently some of the instructors wanted to change the book and with our input it will happen.
I personally feel that many of the diagnoses have a different meaning then what you expect. So without knowing the real meaning you cannot know if it's appropriate.
This past clinical weekend there were a couple people I was helping who picked a diagnosis and when the definition was looked up...the diagnosis wasn't right and we were able to find something that was accurate.
You need to know the definition of the diagnosis and realize the definition is not always what you would expect.
The NANDA book can be bought from their website (takes a while to ship) for about $23. There is another site that sells it for a little less and they might even ship sooner but I don't know.
You need to have a book with the definitions...IMO.
if you just want the bare bones facts about each of the current 188 the nursing diagnoses (definitions, defining characteristics and related factors) you can get them directly from nanda-i in this book which has recently been released: nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. it cost me only $19.95, but i am a member of nanda. it is only a few dollars more if you are not a member. i received mine 2 weeks after ordering it.
what the current care plan and nursing diagnosis books have to offer you is not only the nanda information of nursing diagnosis definitions, defining characteristics and related factors, but usually noc (nursing outcome classifications developed at the university of utah), nec (nursing interventions classifications), and other unique features that each of the various authors has to offer to entice you to buy. the ackley/ladwig book is especially appealing because it contains a 128-page alphabetized index of symptoms, problems, medical diagnoses and clinical states where you can look to find suggestions of nursing diagnoses for particular problems. others have forms for assessment that you can xerox and use. depends on what floats your boat as to why you would buy any particular one.