Need help prioritizing NANDAs

[808wildemel]

Hello everyone,

I am working on a Case Study and I am trying to pick the top 3 nursing diagnoses for the patient in the paper. Here is the paragraph I was given:

"Case Study # 1

A Swedish immigrant was diagnosed with stage II breast cancer at age 44. Her treatment plan included lumpectomy followed by a regimen of chemotherapy and then radiation therapy. She attributed her breast cancer to her depression, which developed when she was a caregiver for her mother, who suffered from Alzheimer's disease. She was diagnosed six months before her mother died.

Following completion of her lengthy breast cancer treatment, Mrs. Z became more depressed. She no longer had frequent visits to the Breast Health Center and missed the interaction with the nurses and other patients. In addition, Mrs. Z feared that her cancer would reoccur and she worried that she would pass it on to her two daughters. She would not discuss her fears with her husband of daughters because she "did not want to be a burden". She began to lose weight and was constantly feeling tired. She felt alone with her cancer and began losing interest in other things. She thought about joining a support group but was embarrassed by her Swedish accent."

Obviously this topic mentions that the pt formerly had breast cancer. It also mentions fatigue and weight loss, however, I don't feel I have enough info on those 2 things to specifically say "imbalanced nutrition" or "insomnia." Those tidbits of information seem more to me like r/t factors for other things. Here is what I was thinking for this case AND in order of priority:

1) Ineffective coping

2) Anxiety

3) Social Isolation

Does this make sense based on this case? Does the priority seem okay? Any advice is appreciated!

Thank you in advance :)

[Esme12, ASN, BSN, RN]

Welcome to AN!

What semester are you? What NANDA resource do you use?

I hope this isn't due tomorrow. I am signing off for tonight but I'll be back bright and early about 5am as I make breakfast for the family. Here are some suggestions I think apply look them up in your NANDA resource and see if they apply

Anxiety

Disturbed Body Image

Defensive Coping

Ineffective Coping

neffective Health Maintenance

Deficient Knowledge (specify)

Moral Distress

Imbalanced Nutrition: less than body requirements

Powerlessness

Chronic low Self-Esteem

Ineffective Self-Health Management

Social Isolation

Stress overload

[808wildemel]

Thanks Esme12,

I am in my third semester of an accelerated BSN program. This class is for Med Surg 1 and we use Ackley's Nursing Diagnosis Handbook (10th ed.). Based on what you wrote above, it seems we are on the same page. What do you think is the PRIORITY?

Thanks again :)

[cayenne06, MSN, CNM]

You always want to look at it from the perspective of the hierarchy of needs. This patient does not appear to have any current medical needs (based on my cursory read; i could be wrong), so addressing the psychosocial component is appropriate.

I think you absolutely need to address her weight loss and fatigue, but I think you are correct that these are a symptom of a larger psychosocial problem. In my professional opinion, ineffective coping is the priority because her anxiety and isolation are likely a result of that. But I've been out of nursing school for two years now, and real-life care planning is oh-so-very different than NANDA-land (at least in my specialty, OBGYN), so take my advice with a grain of salt. :) I don't have a NANDA book at hand so maybe there is a more appropriate diagnosis, idk.

[Esme12, ASN, BSN, RN]

You look at what can kill her first and Maslows Hierarchy of needs. I think she needs some serious education about cancer. I use Ackley and the NANDA bible from NANDA itself. I am going to ask itf this is a real patient...but from what you posted it probably is not. Care plans/case studies are all about the patient assessment. I dislike it when schools makeup these scenarios and give no assessment of the patient.

Looking at the NANDA definitions which ND apply to your patient.

I think....

Anxiety

Ineffective Coping

ineffective Health Maintenance

Deficient Knowledge (specify)

Hopelessness

Imbalanced Nutrition: less than body requirements

Chronic low Self-Esteem

Ineffective Self-Health Management

Social Isolation

Stress overload

All apply now according to Maslows...which would be more important than others?

1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep.

2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.

3. Love and belongingness needs - friendship, intimacy, affection and love, - from work group, family, friends, romantic relationships.

4. Esteem needs - achievement, mastery, independence, status, dominance, prestige, self-respect, respect from others.

5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

[808wildemel]

Thanks Esme12,

I wrote down many of those as possible answers too. To answer your question, yes, this is JUST a scenario and what you read is literally all the information I have to go off. When considering Maslow's hierarchy (and going off the paragraph I have about the client) I don't feel that she has any biological or physiological issues to address. I am aware that the "feels tired" and "lost weight" comments would possibly indicate a lack of those basic needs, but I think greater emphasis is on these other issues she is having and therefore the tiredness and weight loss are r/t factors. I don't feel comfortable enough to say imbalanced nutrition or insomnia based on the little info I have on her.

One thing I will mention is that I know this case is supposed to be related to stress/depression (I know this because my professor said so). Do you think anxiety is the main concern? I kind of feel like anxiety is an easy answer because all patients feel some anxiety. I am more concerned with the fact that she is bottling up her feelings and isolating herself and feels she is a burden. I'm also trying to differentiate between the nandas "ineffective health maintenance" and "ineffective self-health management." They seem very similar. I don't know, I'm still not sure what is her priority since a lot of the NDs are so closely related

[Esme12, ASN, BSN, RN]

Ineffective Coping

Chronic low Self-Esteem

Anxiety

Deficient Knowledge (specify)

This is what I think...you are right about "ineffective health maintenance" and "ineffective self-health management." She actually followed through with treatment. They really don't apply