NANDA Diag.

[Goldenatom]

I'm writing a full (made up) health history and have to come up with some NANDA diagnoses. How do these look?

1. Impaired Gas Exchange, related to COPD, as evidenced by arterial oxygen saturation of 88%.

2. Caregiver role strain, related to wife's cancer treat and son's Down's syndrome care needs, as evidenced by patient statements and patient grooming/hygiene deficit.

3. Deficient fluid volume, related to uncontrolled diabetes and decreased fluid intake, as evidenced by weight loss and visibly dry skin/mucous membranes.

[Daytonite, BSN, RN]

this is the correct sequence of priority and the corrections to the construction:

1. impaired gas exchange, related to copd, as evidenced by arterial oxygen saturation of 88%.
   
   • the related factor must explain why there is a problem with the alveolar-capillary membraneto cause problems with oxygen and carbon dioxide exchange. copd doesn't do it. you need to state, in as few words as possible, how the underlying pathophysiology of copd affects the alveolar-capillary membrane. the taxonomy has already done that for us: alveolar-capillary membrane changes
     

[*]deficient fluid volume, related to uncontrolled diabetes and decreased fluid intake, as evidenced by weight loss and visibly dry skin/mucous membranes.

• deficient fluid volume is dehydration. the definition of this diagnosis specifically tells us it is about fluid loss.
  
• the related factor cannot be a medical diagnosis (uncontrolled diabetes). it can be used, however, by saying "related to _____ secondary to uncontrolled diabetes" if the uncontrolled diabetes is the direct cause of the fluid loss and dehydration.
  
• decreased fluid intake might be a symptom for this diagnosis and not a cause of it per the definition of the diagnosis
  
• the related factor must explain why dehydration is occurring. it will be because of fluid losses or because of failed regulatory body processes that result in fluid losses.
  

[*]caregiver role strain, related to wife's cancer treat and son's down's syndrome care needs, as evidenced by patient statements and patient grooming/hygiene deficit.

• this is a psychosocial diagnosis. . .this diagnosis is about how the patient feels about getting the care done for his wife and son not about how he feels about getting his care done for himself. caregiver role "strain" refers to the pressure put upon the patient to care for others.
  
  • what are some of the patient statements indicating their strain in getting their role as caregiver to the wife and son carried out?
    
  • if the patient has a grooming/hygiene deficit then diagnose dressing/grooming self-care deficit.
    

[Goldenatom]

Thanks so much. So for #3, I could remove the hygiene/grooming part, and actually put the patient statements? So something like, "a.e.b patient stating, "I can't keep up with my wife's needs and my son's needs at the same time anymore."

[Daytonite, BSN, RN]

Thanks so much. So for #3, I could remove the hygiene/grooming part, and actually put the patient statements? So something like, "a.e.b patient stating, "I can't keep up with my wife's needs and my son's needs at the same time anymore."

Yes, that will work.

Fix the first two diagnoses.

[Goldenatom]

1. Impaired Gas Exchange, related to alveolar-capillary membrane changes secondary to COPD, as evidenced by arterial oxygen saturation of 88%.

Is that more appropriate?

I have to come up with two nursing care interventions. Would teaching the patient how to use an incentive spirometer be good?

[Daytonite, BSN, RN]

impaired gas exchange, related to alveolar-capillary membrane changes secondary to copd, as evidenced by arterial oxygen saturation of 88%.

is that more appropriate?

yes.

i have to come up with two nursing care interventions. would teaching the patient how to use an incentive spirometer be good?

will that improve their arterial oxygen saturation and gas exchange? how about having them

do

some is first, then

teach

them is secondly. that makes more sense to me.

there are four types of nursing interventions that you can perform:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
  
  
• care/perform/provide/assist (performing actual patient care)
  
  
• teach/educate/instruct/supervise (educating patient or caregiver)
  
  
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
  
  

[Goldenatom]

Ahh, that makes sense. Would having the patient do deep breathing/coughing and then instruct the patient to do these things also be appropriate interventions?

[Daytonite, BSN, RN]

impaired gas exchange is about gas exchange at the alveoli being impaired, not the larger airways. deep breathing and coughing is going to help, but you also want to maximize their breaths. this diagnosis is about the patient getting good oxygen and carbon dioxide exchange. anything you can do to help the patient achieve that is what your interventions will focus on. so, you want them to be taking good effective inspirations and expirations of air. some positioning will also help or making sure they do not eat so much that their stomachs are gorged and interfere with effective breathing.

[Goldenatom]

I see, thanks so much for the help. Its really hard to put this all together in my mind still.

[twow]

if you will make things up, consider the more useful nanda diagnoses: for example, disturbed energy field or impaired religiosity.

[Goldenatom]

Is something like, "By such and such a date patient will have oxygen saturation above 92%"? Or is that too specific/arbitrary?

[Daytonite, BSN, RN]

Is something like, "By such and such a date patient will have oxygen saturation above 92%"? Or is that too specific/arbitrary?

This is a goal, not an intervention.