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Need help with nursing dx

by msr262 msr262 (New) New

I had a hyponatremic elderly patient (Serum Na ~127, was taking diuretics and forcing fluids, had a suspected seizure the week prior) in my last clinical, and our care plans always get submitted as part of our grade. My clinical instructor is a bit of a stickler. I'm using NANDA 2015-2017 and the only dx for fluid electrolyte imbalances is an "at risk for" and my instructor is adamant that we can't use 'related to and as evidenced by" with potential nursing diagnoses. I really am lost as to what's the best nursing diagnosis for this patient (has to be a physiological one for this particular assignment) since the patient has an actual electrolyte balance. Are there any other NANDA diagnoses I should consider instead? Thanks any insight is appreciated, I'm still very new to writing care plans and I'm not very far along in my nursing education.

Banana nut, BSN, RN, EMT-B

Has 2 years experience.

how about Ineffective health maintenance or Ineffective health management or Frail elderly syndrome?

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

How do your assessment data align with the defining characteristics that are used to determine NDx? Nursing is focused on managing patient actual or potential 'reactions' to abnormal physical and emotional conditions rather than the medical diagnosis based on pathophysiology. So - think about those altered fluid and electrolytes & dust off your old A&P references ... what are the patient's actual or potential reactions? Why did that seizure occur? What are the effects on cognitive function, cardiac output, hemodynamics, etc?

The reason you can't use related factors or evidence for a risk for diagnosis is because it is a *risk*. There are no actual s/sxs. Just risk factors.

The reason you can't use related factors or evidence for a risk for diagnosis is because it is a *risk*. There are no actual s/sxs. Just risk factors.

Absolutely correct. And there is not a thing wrong c that. The NANDA-I has a whole section on safety, and almost everything in there is a "Risk for" diagnosis, because what is a nurse's primary responsibility if not safety?

"Risk for" diagnoses are valid and actual nursing diagnoses, can be the most important ones a given patient has, and I would dare her to prove that they aren't.

Now that that's off my chest....

Let's look at the causes and effects of hyponatremia. Inappropriate water intake? Med interaction? A particular medical condition? Falls? Seizures? Confusion? Inability to do self-care or remember teaching or self-monitor? Increased ICP (which you can't use as a nsg dx unless you have an ICP monitor, but just so you know...). When you expand away from the medical diagnosis and look at the effects on a patient's life and living, that's where you encounter the richness of nursing diagnosis.

Straight No Chaser, ASN, LPN

Specializes in Sub-Acute. Has 5 years experience.

What is your subjective and objective data?

What is the patients history? co morbidities?

What goes along with low sodium?