need help with nursing diagnosis

Clovery · Oct 29, 2011

r/t impaired mobility? decreased circulation?

doesn't your care plan book list related factors? just pick one that fits.

xtxrn, ASN, RN · Oct 29, 2011

my patient has chronic edema of both her lower legs. she also has a complaint of constipation. (she is also wheelchair bound). i'm not sure which nursing diagnosis im coming up with makes the most sense!
constipation related to fluid volume shifting as manifested by chronic edema (or would i say swelling of legs?)
fluid volume excess related to ____?____ as manifested by edema
risk for impaired skin integrity related to _____?____swelling? as manifested by edema
i've been sitting here trying to figure this out for hours now & i'm not getting anywhere!
any suggestions, please??

OK....back up a little bit :) Breathe I'll help all I can.....WITH you- and you're starting off well....just need to back up!

What are the medical diagnoses ? Without those, it's very hard to accurately pinpoint the nursing diagnoses :up:

PCU RN · Oct 29, 2011

OK....back up a little bit :) Breathe I'll help all I can.....WITH you- and you're starting off well....just need to back up!
What are the medical diagnoses ? Without those, it's very hard to accurately pinpoint the nursing diagnoses

she has muscular wasting & tissue atrophy, peripheral vascular disease, atrial fibrilation, hypothyroidism, & chronic edema.

& thank you! i'm in my first semester & still don't quite understand how to put together the best possible diagnosis!

xtxrn, ASN, RN · Oct 29, 2011

my patient has chronic edema of both her lower legs. she also has a complaint of constipation. (she is also wheelchair bound). i'm not sure which nursing diagnosis im coming up with makes the most sense!
constipation related to fluid volume shifting as manifested by chronic edema (or would i say swelling of legs?)
fluid volume excess related to ____?____ as manifested by edema
risk for impaired skin integrity related to _____?____swelling? as manifested by edema
i've been sitting here trying to figure this out for hours now & i'm not getting anywhere!
any suggestions, please??

This is a little trickier since "chronic edema" is technically a symptom- and usually part of something else.

Let's go with constipation first...

Normal bowel function depends on fluid, fiber, food, and function (mobility)..... your patient has messed up fluid status, so some of the fluid could be diverted to her dependent limbs. Hypothyroidism also doesn't help. And neither does the wheelchair.

Does NANDA let you use "constipation" or do you have to use "decreased bowel motility" r/t hypothyroidism, decreased physical mobility (confined to wheelchair), and fluids diverted d/t chronic edema... AEB pt c/o not having BM more than ___x per week ???

Interventions: think about warm fluids/foods at breakfast, PROM of lower extremities, meds as ordered, adequate fluid intake (check w/any limits d/t edema), monitor frequency and give prn laxative as ordered, encourage high fiber food choices, and others you find :)

Goals: Soft, easy to pass BM q ___ days.

Edema.....

Since this is a chronic issue, I'd be more inclined to look at the risk for skin breakdown (also goes with PVD- and decreased sensation)

See what you come up with :) I'll check back.

You may also want to include the fluid volume excess r/t chronic edema AEB taut, shiny skin (if she has that - or what symptoms she's got :)). What sort of interventions are you going to use to keep track of this? To help it decrease? (not just medications)

What is the goal (needs to relate to problem- separate from skin breakdown)

PCU RN · Oct 29, 2011

let's go with constipation first...

normal bowel function depends on fluid, fiber, food, and function (mobility)..... your patient has messed up fluid status, so some of the fluid could be diverted to her dependent limbs. hypothyroidism also doesn't help. and neither does the wheelchair.

does nanda let you use "constipation" or do you have to use "decreased bowel motility" r/t hypothyroidism, decreased physical mobility (confined to wheelchair), and fluids diverted d/t chronic edema... aeb pt c/o not having bm more than ___x per week ???

interventions: think about warm fluids/foods at breakfast, prom of lower extremities, meds as ordered, adequate fluid intake (check w/any limits d/t edema), monitor frequency and give prn laxative as ordered, encourage high fiber food choices, and others you find :)

goals: soft, easy to pass bm q ___ days.

edema.....

since this is a chronic issue, i'd be more inclined to look at the risk for skin breakdown (also goes with pvd- and decreased sensation)

see what you come up with :) i'll check back.

ok! i went with constipation (nanda allows constipation as the dx)

subjective data: pt c/o constipation & swelling in her abdomen. says she is not doing any physical therapy currently.

objective data: chart shows history of constipation with periods of no bm for 5-6 days at a time. she is wheelchair bound. she has chronic edema in both legs.

dx: constipation related to insufficient physical activity (confined to wheelchair), and fluid volume shifting (chronic edema) as manifested by pt c/o not having bm more than 1-2 times per week.

goal #1 & interventions

1) pt will have a soft, formed, easy to pass bowel movement at least every 2 days by 1 month after starting nursing interventions.

1.assess patients hydration status (skin turgor) & bm frequency/ pattern

2.encourage a fluid intake of 1.5 to 2 l/day (unless contraindicated because of edema)

3. encourage patient to start a daily "exercise program" rom excercises she can do from wc.

4. enourage patient to eat high fiber foods so that she consumes the recommended 20-35 grams/day.

5. re-assess patients hydration status & bm frequency/ pattern

goal #2 & interventions

2) client will identify measures that will help prevent or treat her constipation by the end of shift on 10/31/11

1. assess patients current knowledge of food/fluid choices that can lead to easier & more frequent bm

2. educate pt about food/fluid options that can give her better chances for more frequent bm high fiber foods, prune juice, yogurt *with probiotics

3. re-assess patients understanding of better food/fluid choices

let me know what ya think! :down: :up: ??

by the way.. what does d/t mean?

PCU RN · Oct 29, 2011

not sure why some parts of that post came out bold? ..just disregard! there is no extra importance on anything in bold!

xtxrn, ASN, RN · Oct 29, 2011

d/t = due to :)

xtxrn, ASN, RN · Oct 29, 2011

let's go with constipation first...
normal bowel function depends on fluid, fiber, food, and function (mobility)..... your patient has messed up fluid status, so some of the fluid could be diverted to her dependent limbs. hypothyroidism also doesn't help. and neither does the wheelchair.
does nanda let you use "constipation" or do you have to use "decreased bowel motility" r/t hypothyroidism, decreased physical mobility (confined to wheelchair), and fluids diverted d/t chronic edema... aeb pt c/o not having bm more than ___x per week ???
interventions: think about warm fluids/foods at breakfast, prom of lower extremities, meds as ordered, adequate fluid intake (check w/any limits d/t edema), monitor frequency and give prn laxative as ordered, encourage high fiber food choices, and others you find :)
goals: soft, easy to pass bm q ___ days.
edema.....
since this is a chronic issue, i'd be more inclined to look at the risk for skin breakdown (also goes with pvd- and decreased sensation)
see what you come up with :) i'll check back.
ok! i went with constipation (nanda allows constipation as the dx)
subjective data: pt c/o constipation & swelling in her abdomen. says she is not doing any physical therapy currently.
objective data: chart shows history of constipation with periods of no bm for 5-6 days at a time. she is wheelchair bound. she has chronic edema in both legs.
dx: constipation related to insufficient physical activity (confined to wheelchair), and fluid volume shifting (chronic edema) as manifested by pt c/o not having bm more than 1-2 times per week.
goal #1 & interventions
1) pt will have a soft, formed, easy to pass bowel movement at least every 2 days by 1 month after starting nursing interventions.
1.assess patients hydration status (skin turgor) & bm frequency/ pattern
2.encourage a fluid intake of 1.5 to 2 l/day (unless contraindicated because of edema)
3. encourage patient to start a daily "exercise program" rom excercises she can do from wc.
4. enourage patient to eat high fiber foods so that she consumes the recommended 20-35 grams/day.
5. re-assess patients hydration status & bm frequency/ pattern
goal #2 & interventions
2) client will identify measures that will help prevent or treat her constipation by the end of shift on 10/31/11
1. assess patients current knowledge of food/fluid choices that can lead to easier & more frequent bm
2. educate pt about food/fluid options that can give her better chances for more frequent bm high fiber foods, prune juice, yogurt *with probiotics
3. re-assess patients understanding of better food/fluid choices

let me know what ya think! ??

by the way.. what does d/t mean?

what are you going to do if the patient doesn't have a bm for 5 days waiting for that month to come up?

how often are you going to assess?

how often are you going to availability of high fiber foods, or are there any medications that could help that you can ask the doc about ?

how often will you reassess?

is the patient able to read any handouts you might find?

these are good :) just need the time frame. is the patient getting any stool softeners, or fiber supplements? (if fiber, it's really important that the fluid intake be good, or it turns into cement :barf01:

i'll check back :)

xtxrn, ASN, RN · Oct 29, 2011

Also, do you need rationales? :eek:

Maybe include s/s impaction (a VERY big problem, especially in nursing homes- it actually counts against them if the state hears about it).