Need help w/ deficient knowledge nsg dx.

[dukesgal]

So I am working on a care plan for my patient. She had COPD, heart failure, and ultimately had an inferior wall MI and was on a ventilator when I cared for her in the ICU.

We need 3 nursing diagnoses, 1 r/t deficient knowledge.

My 3 are:

Decreased cardiac output r/t ventricular damage

Impaired gas exchange r/t use of mechanical ventilator secondary to increased respiratory rate and body's inability to perfuse itself.

I am having trouble with the third.

The patient was not making any purposeful movements, and could not be aroused when taken off sedation. The client's family was struggling with the decision to take the patient off the ventilator. At first, they did not understand that she would not recover. When I was giving the client meds, one of her sons was asking me what the meds were for. So I did some teaching w/ him regarding the meds and they had asked me what it meant that she did not "come out of it" when we did the sedation vacation.

So I am thinking either Deficient knowledge or ineffective coping. Having problems w/ the r/t factor, but I think I have been at this for far too long.

Thanks!

[rmkelly]

Poor family coping skills d/t deficient knowledge and understanding of educatioin

[Daytonite, BSN, RN]

your care plan must focus on the patient--not the family. is this patient conscious so that teaching is even a possibility? you cannot teach someone anything if they are not conscious and i would discuss that with your instructor. giving instructions to family is tricky and the focus must ultimately relate back to the patient and not the family. consider grieving, compromised family coping, caregiver role strain.

your second diagnosis is constructed incorrectly: impaired gas exchange r/t use of mechanical ventilator secondary to increased respiratory rate and body's inability to perfuse itself.

• a ventilator should not be the cause of the patient's impaired gas exchange. you are saying that the doctor's order for the ventilator and its settings is wrong. you can't do that.
  
• she has copd. the etiology of the impaired gas exchange is physical changes that have occurred in her alveolary and capillary membranes as a result of her copd. if you read about the pathophysiology of copd you would have a better understanding of the physical changes her disease is causing to her lungs.
  
  • the diagnosis should be written as impaired gas exchange r/t alveolar - capillary membrane changes secondary to copd.
    

[DolceVita, ADN, BSN, RN]

Not specifically related to your post I know but....

I was told to be very careful with the deficient knowledge ND. Sometimes pt is not deficient in knowledge but perhaps not motivated or lacking sufficient funds to obtain treatment materials at home.

An example given to me:

pt admitted for complications r/t uncontrolled diabetes isn't ignorant of how to look after themselves but unable to afford their medication (but they may not tell you because it is less embarrassing to them to be considered uneducated about their disease than unable to afford treatment).

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I would also be careful about using the word "poor" alongside "coping". The word "ineffective" is a little less judgmental.

[rmkelly]

I agree ineffective is a better descriptor than poor.